Employment

Personal Information

Name

Address

City

State

Zip Code

Phone

Social Security & Driver’s License Number (will be required at the time of employment)

Email

If hired, can you provide proof that you are legally able to work in the United States?
YesNo

How were you referred to us?
AdvertisementReferralEmployment AgencyWalk-InOther

Have you ever been convicted of a criminal offense (felony or misdemeanor)?
Note An affirmative answer will not necessarily result in disqualification for employment.
YesNo

If yes, please state nature of offense(s), date(s), city, state and disposition of the offense

Has your Driver’s License ever been revoked?
YesNo

Date

If yes, explain

Has License ever been suspended?
YesNo

Date

If yes, explain

Have you been involved in any accidents in the past 5 years?
YesNo

Date

If yes, explain

At this time how many points are on your record?
YesNo

If any, explain

Employment

Position Desired

Are you over 18 years of age?
YesNo

When are you available to begin work?

Employment History

Please account for all employment within the last two (2) years, beginning with your current or more recent employer.

Positions Held

Company Name

Company Address

Company Telephone Number

Dates Employed

From

To

Salary

Job Title

Hours and Days Worked

Supervisor

Is this your current employer?
YesNo

May we contact this employer?
YesNo

Specific Job Duties

Reason for Leaving

Company Name

Company Address

Company Telephone Number

Dates Employed

From

To

Salary

Job Title

Hours and Days Worked

Supervisor

Is this your current employer?
YesNo

May we contact this employer?
YesNo

Specific Job Duties

Reason for Leaving

Personal References

Please list at least two (2) persons NOT related to you who have known you for at least five (5) years.
Include

• Name of Reference

• Address

• Telephone Number

APPLICANT’S STATEMENT

1. The information that I have provided on this application is accurate to the best of my knowledge and may be verified by Goettner Construction or its agents.

2. I authorize all the schools, persons, and organizations named in this application to provide any relevant information in their possession or knowledge to the agents of Goettner Construction, for use in deciding whether or not to offer me employment and specifically waive any required written notification. I hereby release Goettner Construction, my former employers, and all other persons from any and all claims, demands, or liabilities arising out of or in any way related to such inquiry or disclosure.

3. I understand that Goettner Construction is committed to maintaining a drug and alcohol-free workplace. Accordingly, I may be subject to a pre-employment blood test, urinalysis, or another drug/alcohol screening. I further understand that if employed, I may be subject to such a drug and alcohol screening if Goettner Construction has reasonable suspicion to believe that I am under the influence of a drug or alcohol. My consent to submit to such a test is required as a condition of employment and my refusal to consent shall result in a refusal to hire or, if already employed, termination.

4. I understand and agree that any misrepresentation or omission of facts in this application will be justification for refusal or termination of employment, regardless of the time elapsed before discovery.

5. I understand and agree that the employment for which I am applying is at-will and such employment may be terminated at any time with or without cause, without prior notice, by either myself or Goettner Construction. There will be no agreement, express or implied between Goettner Construction and me for any specific period of employment, nor for continuing or long term employment, unless made in writing, signed by an authorized representative of Goettner Construction.

6. I have typed my signature in the space provided below only after I have completed the entire application to the best of my ability and have carefully read the statements above.

Applicant’s Full Name

Date