Please fill out this form completely and accurately so that we may properly have the proper information for our files. If you should encounter any problem or have any questions feel free to contact us.

Today's Date

PERSONAL INFORMATION
Name (Last, First, Middle)

Address

Apt#

City

State

Zip

Social Security#

Phone

Are you at least 18 years of age?

Select one Yes No

How were you referred to ABC?
Select one Friend ABC Employee Newspaper Trade Magazine Employment Agency Internet Search Other
HAVE YOU EVER BEEN CONVICTED OF A CRIME?

Select one Yes No

If yes, explain number of conviction (s), nature of offense (s) leading to conviction (s), how recently such offense (s) was/were committed, sentence (s) imposed, and type (s) of rehabilitation.

Do you have a valid driver's license?

Select one Yes No

Driver's license number

State of issue

Type of License

Select one Operator Commercial (CDL) Chauffeur

Expiration date

My License is currently

Select one Active Suspended

Date of Suspension

Have you had any accidents during the past three years?

Select one Yes No
How many?

Have you had any moving violations during the past three years?

Select one Yes No
How Many?

Only U.S. citizens or aliens who have a legal right to work in the U.S. are eligible for employment. Can you, upon employment provide genuine documentation establishing your identity and eligibility to be legally employed in the U.S.?

Select one Yes No

DESIRED EMPLOYMENT
Position Applying For

Date Available For Work

Are you currently employed?

Select one Yes No

If so, may we inquire of your present employer?

Select one Yes No

Salary Desired

OFFICE Personnel ONLY
Use & knowledge of Microsoft Word

Select one Yes No

Typing

Select one Yes No

WPM

10-key

Processing WPM

Please list computer programs that you have experience with:

Other Skills

EDUCATION
Type of School

Select one High School College Trade, Business Correspondence

Name/Location of School

Years Completed

Did You Graduate?

Select one Yes No

Subjects Studied

MILITARY SERVICE
Branch of Service

From

To

List of service schools attended/relevant job skills learned

FORMER EMPLOYERS
Most Recent or Present Employer
Name of Company

Employed From - To

Address

Phone

Your Job Title and Duties

Supervisor Name

Starting Pay 

Ending Pay 

Reason for Leaving

Name of Company (2)

Employed From - To

Address

Phone

Your Job Title and Duties

Supervisor Name

Starting Pay 

Ending Pay 

Reason for Leaving

Name of Company (3)

Employed From - To

Address

Phone

Your Job Title and Duties

Supervisor Name

Starting Pay 

Ending Pay 

Reason for Leaving

Name of Company (4)

Employed From - To

Address

Phone

Your Job Title and Duties

Supervisor Name

Starting Pay 

Ending Pay 

Reason for Leaving

REFERENCES
Give the names of three persons you are not related to, whom you have known at least one year, listing them below.

Name

Address

Business

Phone

Name

Address

Business

Phone

Name

Address

Business

Phone

OTHER

Are you currently a member of a Labor Union?

Select one Yes No

If so, which Local?

State

List other trade affiliations, training, or additional information if it pertains to desired position:

NOTIFICATION AND AGREEMENT
PLEASE READ BEFORE SIGNING

I CERTIFY THAT ALL ANSWERS GIVEN BY ME ARE TRUE, ACCURATE AND COMPLETE, I UNDERSTAND THAT THE FALSIFICATION, MISREPRESENTATION OR OMISSION OF FACT ON THIS APPLICATION (OR ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTS) WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF EMPLOYMENT, REGARDLESS OF WHEN
OR H0W DISCOVERED.

Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

It is the policy of the company to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, any and other characteristic protected by Federal, State or Local law.

I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment 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.

If hired, I agree to abide by all of the company rules and regulations, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the company or me, I further understand that no representation, whether oral or written by any representative or agent of the Company, at any time, can constitute a contract of employment. I understand that the Company and all Plan Administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms or conditions of employment. No representative or agent of the company, has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by the President or Executive Vice President, or to make any agreement contrary to the foregoing.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.

Applicant Electronic Signature

Date

NOTIFICATION/RELEASE OF INFORMATION FORM
The purpose of this form is to notify you that employment reports will be conducted on you in the course of consideration for employment with ABC Cutting Contractors, Inc.

Name (Last, First, Middle)

Any other name (s) aliases used

Social Security#

DOB*

Age

Driver's license #

State of issue

Present Address

# Yrs at this address

City

State

Zip

Previous cities of residence during past 7 years if different from present address

City

State

Zip

# Yrs at this address

City

State

Zip

# Yrs at this address

In connection with this request I authorize all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, county, and federal courts, and military services to release information about my background including, but not limited to, information about my employment, education, consumer credit history, driving record, criminal record, and general public records history to ABC Cutting Contractors, Inc. This releases the aforesaid parties from any liability and responsibility for collecting the above information.

This authorization, in original or copy form, shall be valid for this and any future reports or updates that may be requested.

Applicant Electronic Signature

Date

Notes: