Employment Application l Cross Creek Construction

Application for Employment

Our policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental disability, or veteran status.

Date:

Last Name:

First Name:

Middle Name:

Street Address:

City:

State:

Zip Code:

Home Phone:

Cell Phone:

Email:

Social Security Number upon Interview or Hiring

Are you a U.S. citizen or otherwise authorized to work in the US on an unrestricted basis? (You may be required to provide documentation.)

Are you over the age of 18? | Yes | No |

Do you have friends or relatives employed by this company? | Yes | No |

If yes, please provide name(s) & relationship:

Are you looking for full-time employment? | Yes | No |

If "no" what hours are you available?

Have you ever been convicted of a felony or a DUI? (This will not necessarily affect your application.) | Yes | No |

If "yes" please describe conditions:

Do you speak English? | Yes | No |

Employment Desired

How did you hear of this opening?

Have you ever applied for employment here? | Yes | No |

When?

Where?

Are you presently employed? | Yes | No |

May we contact your present employer? | Yes | No |

Are you willing to travel? | Yes | No |

If yes, what percent?

Date you can start:

Desired position:

Desired starting salary :

Please list applicable skills:

Education

School Name and Location	Year	Major	Degree
High School:			N/A
College/Trade School:
College/Trade School:
Post-College:
Other Training:

In addition to your work history, are there are other skills, qualifications, or experience that we should consider?

Employment History (Start with most recent employer)

Company Name:
Address:		Telephone:
Date Started:	Starting Wage:	Starting Position:
Date Ended:	Ending Wage:	Ending Position:
Name of Supervisor :
May we Contact? \| Yes \| No \|
Responsibilities:
Reason for Leaving?


Company Name:
Address:		Telephone:
Date Started:	Starting Wage:	Starting Position:
Date Ended:	Ending Wage:	Ending Position:
Name of Supervisor:
May we Contact? \| Yes \| No \|
Responsibilities:
Reason for Leaving?


Company Name:
Address:		Telephone:
Date Started:	Starting Wage:	Starting Position:
Date Ended:	Ending Wage:	Ending Position:
Name of Supervisor:
May we Contact? \| Yes \| No \|
Responsibilities:
Reason for Leaving?

References

List three personal references, not related to you, who have known you for more than one year.
Name:	Phone:	Years Known:
Address:

Name:	Phone:	Years Known:
Address:

Name:	Phone:	Years Known:
Address:

Emergency Contact - In Case of Emergency, Please Notify:

List three personal references, not related to you, who have known you for more than one year.
Name:	Phone:
Address:

Name:	Phone:
Address:

Please Read Before Acknowledging:

I certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application.
I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on this application. In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees. This information is confidential and will not be used for any other purposes.
I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. I agree to undergo testing upon request. I understand that if I refuse to consent to testing, fail to provide a urine sample when requested, provide a false or tampered urine sample or fail to successfully complete the requested drug/alcohol test, I may not be hired by Cross Creek Construction or if employed, may be terminated by Cross Creek Construction.
In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment. I have received from the company a list of the approved documents that are required.
I understand that employment at this company is "at will," which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I hereby acknowledge that I have read and understand the above statements.

I agree with the statement above and agree to all items within the statement. By checking the box below, I acknowledge that I have read the statement and will agree to the above requests if I am asked to in either writing or verbally.

I agree:

Date: