JOB APPLICATION

APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS

PERSONAL INFORMATION

FULL NAME: _________________________________________________________ DATE: ____________

First Middle Last

ADDRESS: ____________________________________________________________________________
Street Address Apt/Suite

______________________________________________________________________
City State Zip Code

E-MAIL: _______________________________________________ PHONE: ________________________

SOCIAL SECURITY NUMBER (SSN): _______-______-_______
DATE AVAILABLE FOR WORK: ___________________________ DESIRED PAY: $________________
POSITION APPLIED FOR: _______________________________________________________
EMPLOYMENT DESIRED: ☐ FULL-TIME ☐ PART-TIME ☐ SEASONAL
EMPLOYMENT ELIGIBILITY
ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S? ☐ YES ☐ NO
HAVE YOU EVER WORKED FOR THIS EMPLOYER? ☐ YES ☐ NO
*IF YES, WRITE THE START AND END DATES: _________________________________________________________________
ARE YOU IN THE CARPENTER’S UNION? ☐ YES ☐ NO
*IF YES, WHAT TERM? ________________________ ☐ ACTIVE ☐ INACTIVE
HAVE YOU EVER BEEN CONVICTED OF A CRIME? ☐ YES ☐ NO
*IF YES, PLEASE EXPLAIN: ________________________________________________________________________________
________________________________________________________________________________________________________
DO YOU HAVE A DRIVER’S LICENSE? ☐ YES ☐ NO DRIVER’S LICENSE/ID #: ____________________________________
WHAT IS YOUR MEANS OF TRANSPORTATION TO WORK? _____________________________________________________

EDUCATION

NUMBER OF
TYPE OF SCHOOL NAME OF SCHOOL YEARS MAJOR/DEGREE
COMPLETED
HIGH SCHOOL

COLLEGE

TRADE SCHOOL

OTHER SCHOOL

MILITARY SERVICE
ARE YOU A VETERAN? ☐ YES ☐ NO

BRANCH: _________________________ RANK AT DISCHARGE: ___________________________________________________

DATE ENTERED: _____________ DISCHARGE DATE: _____________ TYPE OF DISCHARGE: __________________________

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 PREVIOUS EMPLOYMENT

EMPLOYER 1: _______________________________________________ MAY WE CONTACT THIS EMPLOYER? ☐ YES ☐ NO

Company Name
SUPERVISOR NAME: _________________________________________________________ PHONE: _____________________

STARTING PAY: $_______________ ENDING PAY: $______________

JOB TITLE: ___________________________________ EMPLOYMENT START & END DATES: ____________TO ____________

DUTIES PERFORMED: _____________________________________________________________________________________

REASON FOR LEAVING: ____________________________________________________________________________________

EMPLOYER 2: _______________________________________________ MAY WE CONTACT THIS EMPLOYER? ☐ YES ☐ NO

Company Name
SUPERVISOR NAME: _________________________________________________________ PHONE: _____________________

STARTING PAY: $_______________ ENDING PAY: $______________

JOB TITLE: ___________________________________ EMPLOYMENT START & END DATES: ____________TO ____________

DUTIES PERFORMED: _____________________________________________________________________________________

REASON FOR LEAVING: ____________________________________________________________________________________

EMPLOYER 3: _______________________________________________ MAY WE CONTACT THIS EMPLOYER? ☐ YES ☐ NO

Company Name
SUPERVISOR NAME: _________________________________________________________ PHONE: _____________________
STARTING PAY: $_______________ ENDING PAY: $______________

JOB TITLE: ___________________________________ EMPLOYMENT START & END DATES: ____________TO ____________

DUTIES PERFORMED: _____________________________________________________________________________________

REASON FOR LEAVING: ____________________________________________________________________________________

PROFESSIONAL REFERENCES

FULL NAME: _______________________________________________________ RELATIONSHIP: ________________________

COMPANY: ____________________________________________________ PHONE: ___________________________________

FULL NAME: _______________________________________________________ RELATIONSHIP: ________________________

COMPANY: ____________________________________________________ PHONE: ___________________________________

FULL NAME: _______________________________________________________ RELATIONSHIP: ________________________

COMPANY: ____________________________________________________ PHONE: ___________________________________

QUALIFICATIONS
Use the space below to summarize any additional information necessary to describe your full qualifications for the
specific position for which you are applying: _________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

DID YOU COMPLETE THIS APPLICATION BY YOURSELF? ☐ YES ☐ NO

IF NOT, WHO DID? __________________________________________________________________________________

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 PLEASE READ CAREFULLY

APPLICATION FORM WAIVER

In exchange for the consideration of my job application by Cheltenham Construction Services, Inc.
(hereinafter called “the Company”), I agree that:
Neither the acceptance of this application nor the subsequent entry into any type of employment
relationship, either in the position applied for or any other position, and regardless of the contents of
employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist
from time to time, or other Company practices, shall serve to create an actual or implied contract of
employment, or to confer any right to remain an employee of Cheltenham Construction Services, Inc., or
otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and
that relationship cannot be altered except by a written instrument signed by the President /General Manager
of the Company. Both the undersigned and Cheltenham Construction Services, Inc. may end the
employment relationship at any time, without specified notice or reason. If employed, I understand that the
Company may unilaterally change or revise their benefits, policies and procedures and such changes may
include reduction in benefits. I understand and agree that, if hired, my employment will be for no definite
period and may, regardless of the date of payment of wages, be terminated at any time without previous
notice and with or without reason, at the will of either myself or the company.

I authorize investigation of all statements contained in this application. I understand that the
misrepresentation or omission of facts called for is cause for dismissal at any time without any previous
notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise
indicated), references, and others, and hereby release the Company from any liability as a result of such
contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for preemployment
testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of
my employment; and (3) continued employment is based on the successful passing of testing under such
policy. I further understand that continued employment may be based on the successful passing of job-
related physical examinations.

I understand that, in connection with the routine processing of your employment application, the Company
may request from a consumer reporting agency an investigative consumer report including information as to
my credit records, character, general reputation, personal characteristics, and mode of living. Upon written
request from me, the Company, will provide me with additional information concerning the nature and scope
of any such report requested by it, as required by the Fair Credit Reporting Act.

I further understand that my employment with the Company shall be probationary for a period of sixty (60)
days, and further that at any time during the probationary period or thereafter, my employment relation with
the Company is terminable at will for any reason by either party.

Signature of applicant: _________________________________________ Date: ___________________

This Company is an equal employment opportunity employer. We adhere to a policy of making employment
decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or
disability. We assure you that your opportunity for employment with this Company depends solely on your
qualifications.

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