Carnation Building Services, Inc. Application for Employment Notify the person who gave you this form if you need help completing the form or have questions during any stage of the employment process. Every effort will be made to accommodate your needs. Applicant Instructions: Please complete all three pages of this application. DO NOT COMPLETE ANY ADDITIONAL ATTACHED FORMS UNTIL INSTRUCTED TO DO SO.  Answer all appropriate questions accurately and  Print clearly except for signature. Incomplete or illegible completely. applications will not be processed.  Write “NOT APPLICABLE” rather than leave an answer  Provide requested Information only. blank.  Failure to follow these instructions may result in disqualification  Use comments section if you need more space. of your application. Position applying for: _____________________________________________________________________Today's Date: __________________ Last Name: ____________________________________________________ First Name: ____________________________ Middle Initial: ____ Current Address: (street) _____________________________ City: ____________ State: _____ Zip Code: __________ Phone: ______________ Previous Addresses: (if you have lived at your current address for less than 7 years, please list the cities, counties and states in which you have lived during the past 7 years.) 1 City:_____________________________ County:____________________ State:________________ From:___________ To:____________ 2 City:_____________________________ County:____________________ State:________________ From:___________ To:____________ 3 City:_____________________________ County:____________________ State:________________ From:___________ To:____________ Additional Information Please list any other names you have used in the past and the approximate dates you used them _______________________________________ _____________________________________________________________________________________________________________________ Yes  No Yes  No Yes  No Yes  No Yes  No If hired, can you provide proof that you are eligible to work in the United States? Are you 18 years of age or older? (If hired, you may be required to submit proof of age) Have you ever applied her before? If yes, when? ______________________________ Were you ever employed here? If yes, when? ________________________________ Have you ever been convicted of a crime? If so, please provide details below, including the county in which you were convicted. Include any pleas of "guilty" or "no contest" but exclude any minor traffic violations. A conviction will not necessarily disqualify you from employment. ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Availability When can you start your employment? ________________  Weekdays  Weekends  Evenings  Nights  Overtime  Full-time  Part-time  Temporary  On-call What schedules are you available to work? What Category would you prefer? Best way to contact you: Email_______________________________ Cell Phone________________ Home Phone_________________________ ©2015 Carnation Building Services, Inc. Full and Part-Time Education - DO NOT FILL OUT ANY PART OF THIS SECTION YOU BELIEVE TO BE NON-JOB RELATED Please circle (select) the highest grade completed: 7 8 9 10 11 12 13 14 15 16 16+ If school records are listed under a different name(s) than your current name, please list those names: ________________________________ Name City/State Graduated (Yes or No) Degree Type High School: College: Other: Other: Employment Information: Most Recent Employer Company Name: __________________________________________ Company Phone Number (with area code): _______________________ Address: _______________________________________________________ City: ____________________________ State: _____________ Supervisor Name/Title: ________________________________________________ Phone Number (with area code): ____________________ Dates Employed: ________________ to ________________Job Title (start): _____________________ (end): __________________________ Salary (start): $_________ (end): $__________ Are you still employed by this employer?  Yes  Hourly  Weekly  Monthly  Temporary or Contract  No If no, reason for leaving: __________________________________________________________________________________________  Yes  No May we contact your employer? If you worked at this employer through a temporary agency, please complete the following: Agency: _______________________________ Address: _______________________________ Phone Number: _____________________ Previous Employers Company Name: ___________________________________________ Company Phone Number (with area code: _______________________ Address: _______________________________________________________ City: ____________________________ State: ______________ Supervisor Name/Title: _______________________________________________ Phone Number (with area code): ______________________ Dates Employed: ________________ to ________________Job Title (start): ______________________ (end): __________________________ Salary (start): $_________ (end): $__________ Are you still employed by this employer?  Yes  Hourly  Weekly  Monthly  Temporary or Contract  No Reason for leaving: ___________________________________________________________________________________________ May we contact your employer?  Yes  No If you worked at this employer through a temporary agency, please complete the following: Agency: _______________________________ Address: _______________________________ Phone Number: _______________________ ©2015 Carnation Building Services, Inc. Company Name: ___________________________________________ Company Phone Number (with area code: ________________________ Address: _____________________________________________________ City: ____________________________ State: _________________ Supervisor Name/Title: __________________________________________________ Phone Number (with area code): ____________________ Dates Employed: ________________ to ________________Job Title (start): _____________________ (end): ____________________________ Salary (start): $_________ (end): $__________ Are you still employed by this employer?  Yes  Hourly  Weekly  Monthly  Temporary or Contract  No Reason for leaving: _____________________________________________________________________________________________________ May we contact your employer?  Yes  No If you worked at this employer through a temporary agency, please complete the following: Agency: _______________________________ Address: __________________________Phone Number (with area code): __________________ APPLICANT NOTICE: This is not an employment contract. This form will be used to evaluate your qualifications for employment. False or misleading answers or statements made on this form or during an interview are grounds for terminating the application process or, if discovered after employment, terminating employment. We intend for all qualified applicants to be given equal opportunity and that selection decisions be based on job-related factors. None of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information. We do not discriminate on the basis of race, color, religion, national origin, sex, marital status, age, creed, military reserve membership, ancestry, disability, or any other status protected by law or regulation. Testing for job-related skills and for the presence of illicit drugs in your body may be required prior to or during employment. Depending on company policy and the requirements of the job, we may require that you complete a medical history form and be examined by a medical professional designated by the company. Affidavit, Certification, Consent and Release PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING I certify that I have read and understand the APPLICANT NOTICE above and that all information provided in this employment application and all statements made by me are true and complete. I understand that any false or misleading answers, omissions or misrepresentations of facts, whether on this document or not, may disqualify me from further consideration for employment, termination of the application process or, if discovered later, discharge at any time during my employment. I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre-and/or post-employment drug screen as a condition of employment, if company policy requires. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete re-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. Medical and Workers Compensation information will only be requested in compliance with the Federal Americans with Disabilities Act (ADA) and/or any other applicable state laws. I understand and acknowledge that as directed by company policy, a consumer report (including a credit report) or investigative consumer report may be compiled on me. I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, corporation, law enforcement agency, credit bureau, courts record repository, department of motor vehicles, past of present employer, educational institution, governmental occupational licensing or registration entity, business or personal references and any other source required to verify information that I have voluntarily supplied or to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability for any damage whatsoever issuing this information. I have read, understand, and by my Signature, consent to these statements. Applicant's Signature __________________________________________________ Today's Date __________________________________ ©2015 Carnation Building Services, Inc. Submit by Email