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Application for Employment  Pre-Employment Questionnaire
An Equal Opportunity Employer

We are always in the market for good installers, estimators and laborers. (Please submit only once).
NOTE: We are an Eastern Company doing work in Washington, DC, VA, MD, and PA areas only. In order to get a response you must have an e-mail address.

Step 1 Personal Information  

Last Name:

First Name:

Middle Name;

Social Security Number:

Present Address:

City, State Zip Code:

Permanent Address if different:

Daytime Phone:

Evening Phone:

E-mail Address:

Are you 18 years or older?

If no, state your birthday:

Do you have the legal right to work in the U.S.?

Have you been convicted of a felony in the last seven (7) years?

Some convictions may be relevant if related to a proposed job, but is not a bar to a job.

Step 2 Employment Desired  

Position applying for:

Date you can start:

Type of employment desired (Full/Part Time):

Hours available:

Days of the week available:

Are you available for OT?

Who referred you to us?

Please list friends or relatives working here:

Step 3 Military Service

Branch of Service:

Date of Discharge:

Rank last held:

Applicable special skills:

Step 4 Education History High School

High School or GED Name:

High School Address:

Major Course of Study:

Graduate:

College School

College Name:

College  Address:

Major Course of Study:

Graduate:

Special Related Degrees:

Graduate School

Graduate School Name:

Graduate School Address:

Major Course of Study:

Graduate:

Special Related Degrees:

Step 5 Employment History Current Employer

Employer Name:

Employer Address:

City, State -- Zip Code:

Telephone Number:

Supervisor's Name:

Employed From:

Employed To:

Reason for leaving:

Previous Employer
Employer Name:
Employer Address:
City, State -- Zip Code:
Telephone Number:
Supervisor's Name:
Employed From:
Employed To:
Reason for leaving:
Previous Employer
Employer Name:
Employer Address:
City, State -- Zip Code:
Telephone Number:
Supervisor's Name:
Employed From:
Employed To:
Reason for leaving:

Step 6 General Information 

Subjects of special study or research:
Special Training:
Special Skills:

Step 7 List References Below

Name
Address:
Phone:
How Related (Family/Friend):

References #2

Name
Address:
Phone:
How Related (Family/Friend):

References #3

Name
Address:
Phone:
How Related (Family/Friend):
Comments:

Please read the authorization section below before you submit this application.  Your submission will be considered your authorization.

 

Authorization

I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES AND EMPLOYERS LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE AND RELEASE THE COMPANY FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM UTILIZATION OF SUCH INFORMATION.

I ALSO UNDERSTAND AND AGREE THAT NO REPRESENTATIVE OF THE COMPANY HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING, UNLESS IT IS IN WRITING AND SIGNED BY AN AUTHORIZED COMPANY REPRESENTATIVE. 

Equal Employment Opportunity

The Company provides equal employment opportunity for everyone regardless of age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability that does not prohibit performance of essential job functions.  In addition, laws regarding veterans' status are observed.

This is reflected in all the company practices and policies regarding hiring, training, promotions, transfers, rates of pay, layoff, and other forms of compensation.

All matters relating to employment are based upon ability to perform the job, as well as dependability and reliability once hired.