APPLICATION FOR EMPLOYMENT


DATE:  
APPLICANT TO COMPLETE ALL INFORMATION REQUESTED
The Company provides equal employment opportunities to all employees and applicants without regard to race, color, ancestry, religion, sex, sexual orientation, national origin, creed, citizenship status, age, disability, medical condition, pregnancy, military status, marital status, or status as a Vietnam-era or special disabled veteran in accordance with applicable federal and state laws. In addition, the Company complies with applicable state and local laws governing nondiscrimination in employment in every location in which the Company has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Name:
Social Security No.
Current Address:
Previous Address:
Email Address: Primary Phone #: Other Phone #:
Are you legally eligible for employment in United States? Yes(proof required)  No Are you over 18? Yes No

COMPANY EXPERIENCE
Have you worked for the company before? Where:
Dates:
Date From: To:
Supervisor: Rate of Pay:
Position:Reason for Leaving:

GENERAL
Are you currently employed? If not, when was your last day employed?
Position Applying For:
 Part Time  Full Time
 Temporary  Contract
Who referred you? Rate of Pay expected?
Have you ever pled "guilty" or "not guilty" to, or been convicted of a crime?
If YES, Please provide dates and details:
Answering "YES" to these questions does not constitute an automatic bar to employment. Factors such as date of offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

EDUCATION BACKGROUND
TYPE OF SCHOOLName and LocationDid you graduate?DIPLOMA/DEGREE
High School
College
Technical School
Other School
Other Skills/Training (describe):
Are you a Veteran?    
If YES, please list any special skills or training:

LIST ALL PRESENT AND PAST EMPLOYMENT (Most recent first) – SEVEN (7) YEARS MINIMUM
Company Name
Address,City,State,Zip
Phone Number
Type of Business
Name of Supervisor
Phone#
INCOME
Starting Wage Hourly  Yearly
Now or Ending Wage Hourly  Yearly
DATES WORKED
FROM TO
POSITION HELD
DUTIES/RESPONSIBILITIES
REASON FOR LEAVING

LIST ALL PRESENT AND PAST EMPLOYMENT (Most recent first) – SEVEN (7) YEARS MINIMUM
Company Name
Address,City,State,Zip
Phone Number
Type of Business
Name of Supervisor
Phone#
INCOME
Starting Wage Hourly  Yearly
Now or Ending Wage Hourly  Yearly
DATES WORKED
FROM TO
POSITION HELD
DUTIES/RESPONSIBILITIES
REASON FOR LEAVING

LIST ALL PRESENT AND PAST EMPLOYMENT (Most recent first) – SEVEN (7) YEARS MINIMUM
Company Name
Address,City,State,Zip
Phone Number
Type of Business
Name of Supervisor
Phone#
INCOME
Starting Wage Hourly  Yearly
Now or Ending Wage Hourly  Yearly
DATES WORKED
FROM TO
POSITION HELD
DUTIES/RESPONSIBILITIES
REASON FOR LEAVING

LIST ALL PRESENT AND PAST EMPLOYMENT (Most recent first) – SEVEN (7) YEARS MINIMUM
Company Name
Address,City,State,Zip
Phone Number
Type of Business
Name of Supervisor
Phone#
INCOME
Starting Wage Hourly  Yearly
Now or Ending Wage Hourly  Yearly
DATES WORKED
FROM TO
POSITION HELD
DUTIES/RESPONSIBILITIES
REASON FOR LEAVING

SPECIAL SKILLS


Please describe any skills training including language that you have received.
List special accomplishments, publications, awards, etc. Please exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age mental or physical disabilities or my other similarly protected status.



REFERENCES


List name and telephone number of three (3) business/work references who are not related to you. If not applicable, list three (3) school or personal references who are not related to you.

NAMEPHONE NUMBERRELATIONSHIPYEARS KNOWN

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct. I understand that successful completion of a pre-employment test for drugs and controlled substances is required prior to employment. Prior to testing I agree to sign MJB Wood Group's authorization forms wherein I agree to submit to such testing and to authorize the release of the results to MJB Wood Group. I understand the test will be conducted at MJB Wood Group's expense and by a health care provider selected by MJB Wood Group. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered. I expressly authorize, without reservations, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state, or federal law. I understand that his application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute and agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative or the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT. I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Signature of ApplicantDate

DRIVER EXPERIENCE & QUALIFICATION
(Answer the questions in this section only if you will be driving a company owned or leased vehicle)
LICENSES
State License No. Class Endorsement(s) Expiration Date
Drivers
Licenses held
in the past 5
years must be
shown here.

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?  Yes  No
B. Have any license, permit or privilege ever been suspended or revoked?  Yes  No
C. Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?  Yes  No
If you answered "YES" to A, B, C attach a statement giving details. Yes No

Driving Experience Please list below the Class, Type of equipment, and years experience on each, including approximant total miles driven.

List states operated in during the past 5 years:
List special training or awards received in past 5 years:

Accident Review for the past 5 years. Please list below the DATES in chronological order, nature of accident, any fatalities or injuries.

Traffic Convictions and forfeitures in the past 5 years other than parking violations.
LocationDateChargePenalty

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