A&S Construction, inc

Employment Application

 

Applicant Information

Last Name

 

First

 

M.I.

Date

 

Street Address

 

Apartment/Unit #

 

City

 

State

 

ZIP

 

Phone

 

E-mail Address

 

Date Available

 

Social Security No.

 

Desired Salary

 

Position Applied for

 

Are you a citizen of the United States?

YES 

NO 

If no, are you authorized to work in the U.S.?

YES 

NO 

Have you ever worked for this company?

YES  

NO  

If so, when?

 

Have you ever been convicted of a felony?

YES  

NO  

If yes, explain

 

 

Education

High School

 

Address

 

From

 

To

 

Did you graduate?

YES 

NO 

Degree

 

College

 

Address

 

From

 

To

 

Did you graduate?

YES 

NO 

Degree

 

Other

 

Address

 

From

 

To

 

Did you graduate?

YES 

NO 

Degree

 

 

References

Please list three professional references.

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 

 

Previous Employment

Company

 

Phone

(           )

Address

 

Supervisor

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

From

 

To

 

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES 

NO 

 

Company

 

Phone

(         )

Address

 

Supervisor

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

From

 

To

 

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES 

NO 

 

Company

 

Phone

(         )

Address

 

Supervisor

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

From

 

To

 

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES 

NO 

 

 

Military Service

Branch

 

From

 

To

 

Rank at Discharge

 

Type of Discharge

 

If other than honorable, explain

 

 

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.

Signature

 

Date

 

 

 

 

 

 

 

authorization for release of information

This form authorizes previous employers to release information regarding employment history including abilities, work ethics, drug and alcohol testing results and safety habits.

Signature

 

Date

 

 

 

1.      Was the applicant employed by your company? _______________________________

2.     Please include his dates of employment   Hired _____________________  Released _______________________

3.     Reason for Releasing Applicant   ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4.     What did the applicant do for your company?  _____________________________________________________________________________

___________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________

5.      On a scale of 1 to 5 with 1 being low and 5 being high please rate the applicant on the following

Quality of work :                                    1              2              3              4              5

Cooperation with Others:                     1              2              3              4              5

Safety Habits:                                        1              2              3              4              5

Personal Habits;                                    1              2              3              4              5

Attitude:                                                 1              2              3              4              5

Tardiness               :                                               1              2              3              4              5

 

6.      Would you rehire applicant?  If not why?     ______________________________________________________________________________

 

 

 

Previous Employer Contact Information

Please provide a specific contact name for the person responding to this request.  This is required in the event the applicant chooses to contact you regarding the information you provide.

Contact Name:

Title:

Telephone:

Fax:

Mailing Address:

Signature of Company Official releasing this Information: