Employee Application – Bilbrey Construction

Name:

First*

Middle*

Last*

Email*

Address

Street Address Apartment # City State Zip Code

Primary Phone*

Secondary Phone

Do you have any physical condition which may limit your ability to perform the particular job for which you are applying?

Physical Condition(s)*

Yes

If yes, describe such condition:

What method of transportation will you use to get to work?*

Position(s) applied for:*

Rate of pay expected ($ per week):*

I am interested in working:*

Full-Time

Part-Time

Specify days and hours, if part-time:

Were you previously employed by us?*

Yes

If yes, when?

List any relatives or friends working for us:

If your application is considered favorably, on what date would you be available for work?*

Are there any other experiences, skills or qualifications which you feel would especially fit you for work with our organization?

Additional qualifications:

EMPLOYMENT HISTORY
List current employment first

Employer 1: Company Name, Address & Telephone

Employer 1: Date Started

Employer 1: Date Ended

Employer 1: Position

Employer 1: Starting Salary

Employer 1: Ending Salary

Employer 1: Reason for Leaving

Employer 1: Supervisor Name

Employer 2: Company Name, Address & Telephone

Employer 2: Date Started

Employer 2: Date Ended

Employer 2: Position

Employer 2: Starting Salary

Employer 2: Ending Salary

Employer 2: Reason for Leaving

Employer 2: Supervisor Name

Employer 3: Company Name, Address & Telephone

Employer 3: Date Started

Employer 3: Date Ended

Employer 3: Position

Employer 3: Starting Salary

Employer 3: Ending Salary

Employer 3: Reason for Leaving

Employer 3: Supervisor Name

Employer 4: Company Name, Address & Telephone

Employer 4: Date Started

Employer 4: Date Ended

Employer 4: Position

Employer 4: Starting Salary

Employer 4: Ending Salary

Employer 4: Reason for Leaving

Employer 4: Supervisor Name

May we contact the above employers?*

Yes

If not, indicate by number which one(s) you do not wish us to contact:

PERSONAL REFERENCES
Not former employers or relatives

Reference 1: Name & Occupation

Reference 1: Address

Street Address Apartment # City State Zip Code

Reference 1: Phone

Reference 2: Name & Occupation

Reference 2: Address

Street Address Apartment # City State Zip Code

Reference 2: Phone

Reference 3: Name & Occupation

Reference 3: Address

Street Address Apartment # City State Zip Code

Reference 3: Phone

Reference 4: Name & Occupation

Reference 4: Address

Street Address Apartment # City State Zip Code

Reference 4: Phone

Additional information you would like to provide to us:

"I authorize Bilbrey Construction, Inc. to obtain my employment and personal references, and to contact the employment and personal references, except as indicated above, upon consideration of employment with Bilbrey Construction, and, if employed by Bilbrey Construction, to provide references on my employment with Bilbrey Construction, Inc. to prospective future employers."

Employment Authorization*

I agree

I do not agree

RECORD OF EDUCATION

High School: Name & Location

High School

Graduated? Y/N

Years Completed

College/Trade School: Name & Location

College/Trade School

Graduated? Y/N

Years Completed

College/Trade School: Course of Study & Degree

"I authorize Bilbrey Construction, Inc. to verify the information I provide regarding my education and employment, upon consideration of employment with Bilbrey Construction.”

Education Authorization*

I agree

I do not agree

DRUG & ALCOHOL POLICY

It is Bilbrey Construction, Inc.'s policy to maintain a safe and productive "Drug and Alcohol Free" work place for its employees, subcontractors, and its customers. Drug and alcohol use is highly detrimental to the safety and productivity of employees in the work place.

Prior to employment, but after a conditional job offer has been made to an applicant, Bilbrey Construction will require applicants to first pass a drug/alcohol screening done by an independent testing lab of the employer's choice and at the expense of the employer. A "positive" drug test result for an applicant will result in the withdrawal of the offer of employment.

MILITARY SERVICE RECORD

Were you in the U.S. Armed Forces?*

Yes

If yes, what branch?

Dates of duty:

Rank at discharge:

List duties in the service, including special training:

Have you taken any training under the GI Bill of Rights?

Yes

If yes, what training?

AT-WILL DISCLAIMER

If employed by Bilbrey Construction, Inc., you will be issued an employee Handbook. This Handbook does not create a contract of employment, either express or implied, between Bilbrey Construction, Inc. and the applicant for employment, hours of work, or the providing of benefits. Therefore, Bilbrey Construction, Inc. employees are employees-at-will.

“I attest that the information provided in this application for employment is accurate; and am aware that falsification of any answer on this application will be grounds for my immediate dismissal and may result in denial of workers’ compensation benefits.”

Attestation*

I agree

I do not agree