Employment Application

Position(s) Desired or Area of Interest

Personal Information

First Name*

Middle Name

Last Name*

Email*

Phone

Best Time to Call

Morning
Afternoon
Evening

Please list your address(es) for the past 3 years.

Current Address*

Street Address Address Line 2 City State ZIP Code

How Long At Current Address*

Prior Address 1

Street Address Address Line 2 City State ZIP Code

How Long At Prior Address 1

Prior Address 2

Street Address Address Line 2 City State ZIP Code

How Long At Prior Address 2

Prior Address 3

Street Address Address Line 2 City State ZIP Code

How Long At Prior Address 3

Employment Questions

Are you willing to work*

may mark more than one

Date Available*

Have you ever worked for Corporate Contractors Inc. or a related company?*

Yes
No

If Yes, when and in what position?

Are you 18 years of age or older?*

Yes
No

Will you work overtime if asked?*

Yes
No

If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?*

Yes
No

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodations?*

Yes
No

Education/Training

Last High School / GED

List:
- Name and Location of School
- Diploma, Degree, Certificate or Credits Earned
- Course of Study
- Did You Graduate

College or University

List:
- Name and Location of School
- Diploma, Degree, Certificate or Credits Earned
- Course of Study
- Did You Graduate

College or University

List:
- Name and Location of School
- Diploma, Degree, Certificate or Credits Earned
- Course of Study
- Did You Graduate

Graduate School

List:
- Name and Location of School
- Diploma, Degree, Certificate or Credits Earned
- Course of Study
- Did You Graduate

Technical / Vocational School

List:
- Name and Location of School
- Diploma, Degree, Certificate or Credits Earned
- Course of Study
- Did You Graduate

List applicable courses, seminars, workshops and training programs you attended related to this position:

Other Special Training or Skills (languages, machine operation, etc.) which you feel are relevant to the job for which you are applying:

Conviction Information

Have you been convicted of a crime in the last 15 years, excluding misdemeanors and those which have been sealed, expunged or statutorily eradicated?*

A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question.

Yes
No

If yes, explain each conviction

Military

Have you served in the Armed Forces?*

Yes
No

If yes, when?

What branch?

Duties performed / specialized training received

Licenses

Complete this section only if applying for any of the following positions: Manager, Project Manager, Asst. PM, Supervisor, Driver, Equipment Operator, Carpenter, Roofer, Concrete, Mason, or Laborer.

Do you have a valid driver’s license?*

Yes
No

Drivers License Number*

Drivers License State

List all moving traffic violations within the past five years:

Include nature of offense, date and explain in further detail.

References

Please list your employment history for the past ten (10) years. Begin with most recent employment. Attach additional pages if necessary. List any relevant volunteer work experience.

List three (3) persons who are not related to you and who have definite knowledge of your business or professional qualifications for the position for which you are applying. Do not repeat names of Supervisors listed under work history.*

Include name, phone, email and relationship

Employment History

Present or Last Employer (Most Recent)

Company Phone

Company Address

Street Address City State / Province / Region ZIP / Postal Code

Start Date

MM

DD

YYYY

End Date

MM

DD

YYYY

Are you currently employed with this company?

Yes
No

Supervisor’s Name and Title

May we contact this employer?

Yes
No

Hours Worked Per Week

Base Rate of Pay (Hour/Week/Month)

Job Title and Describe Your Work

Operated CDL Equipment?

Yes
No

Reason for leaving?

Previous Employer (Second Most Recent)

Company Phone

Company Address

Street Address City State / Province / Region ZIP / Postal Code

Start Date

MM

DD

YYYY

End Date

MM

DD

YYYY

Supervisor’s Name and Title

May we contact this employer?

Yes
No

Hours Worked Per Week

Base Rate of Pay (Hour/Week/Month)

State Job Title and Describe Your Work

Job Title and Describe Your Work

Operated CDL Equipment?

Yes
No

Reason for leaving?

Previous Employer (Third Most Recent)

Company Phone

Company Address

Street Address City State / Province / Region ZIP / Postal Code

Start Date

MM

DD

YYYY

End Date

MM

DD

YYYY

Supervisor’s Name and Title

May we contact this employer?

Yes
No

Hours Worked Per Week

Base Rate of Pay (Hour/Week/Month)

Job Title and Describe Your Work

Reason for leaving?

Corporate Contractors Inc. is an Equal Opportunity Employer. We do not discriminate in hiring or employment because of race, color, creed, national origin, sex, disability or veteran status. To further our commitment to Equal Employment Opportunity, we request your cooperation in voluntarily providing the following information which is essential to the success of our program. Any information gathered is strictly confidential and will be filed in a separate filed from your application for employment.

How were you referred to our organization?*

AUTHORIZATION, RELEASE AND CERTIFICATION I certify that all information on this application is true, complete and correct to the best of my knowledge. I understand that any false or misleading statements by me, or material omissions of information requested of me, may result in rejection of my application or, if employed, my immediate dismissal. I hereby give permission to Corporate Contractors Inc. to seek to verify and supplement the information set forth in the application including reference checks. I release from all liability or legal claims every person seeking or providing information, whether oral or written. A photocopy of this release shall be as valid as the original, and may be relied upon by all persons providing information. I understand that employment with Corporate Contractors Inc. is not contractual and is at-will. I understand and agree that, if hired, I may voluntarily leave employment at any time, and may be terminated at any time without prior notice for any reason, or for no reason. I understand that any oral or written statements which I may claim to have made to me now or in the future inconsistent with the provisions of this paragraph, are expressly disavowed and revoked by the company, and should not be relied upon by me as an applicant for employment or as an employee, if hired. I understand that I may be required to submit to a medical examination if offered a position conditioned on such examination. I also understand that I may be required to submit for testing for controlled substances or other drugs. I understand this application will be considered inactive after 1 year. I certify that I have read (or have had read to me) and understand this Authorization, Release and Certification.

Printing your First Name + Middle Initial + Last Name will act as your digital signature.*

Date Signed

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