Employment

POSITION APPLIED FOR
How Do we Contact You?
How did you learn about us?
Education

High School

Diploma   Other (Specify)   None  

COLLEGE, UNIVERSITY OR PROFESSIONAL SCHOOL: (TRANSCRIPTS MAY BE REQUIRED)

Name of School Location Dates Of Attendance (Years) Major/Minor course of Study Type of Degree earned
    From To    

JOB RELATED TRAINING OR COURSE WORK: (VOCATIONAL, TRADE, GOVERNMENTAL, BUSINESS, ARMED FORCES, ETC.)

Name of School Location Dates Of Attendance (Years) Course of Study Training Completed earned
    From To    
Yes No
Yes No

LICENSURE, REGISTRATION, CERTIFICATION EXAMPLES: Driver License, Certificates related to HVAC, Electrical, Plumbing, Etc.

License, Registration or Certificate: Number Exp. Date Valid Currently? State Licensing Agency
Yes No
Yes No

If you are a licensed driver, have you had any traffic violations
in the last five (5) years? Yes No

CURRENT EMPLOYMENT / AVAILABILITY

Are you currently employed? Yes No

If yes, may we contact your present employer? Yes No

Which of the following are you
available to work: Full Time Part Time Shift Temporary

Are you currently on a 'Lay Off' status and subject to recall? Yes No

PERIODS OF EMPLOYMENT

Describe your work experience in detail, beginning with your current or most recent job. Use a separate block to describe each position. Include military service (indicate rank) and job-related volunteer work, if applicable. Indicate number of employees supervised. Provide an explanation of any gaps in employment. Resumes are acceptable for the description of duties and responsibilities only. All other information in this section must be completed.

 

 

PERSONAL AND/OR PROFESSIONAL REFERENCES

Please list at least 3 each references in the spaces provided below:

Name Relationship Telephone Known How Long?
SKILLS

List skills you possess and believe relevant to the position you seek, such as operating heavy equipment, computer skills, other technical or mechanical skills, etc.

SPECIALIZED SKILLS for Office Positions

Check Skills / Equipment Operated

Personal Computer

Microsoft Office (Word, Excel, Outlook, etc)

Blueprint Machine

Fax Machine

Multi-Line Telephone

Estimating Software

Photocopy Machine

Accounting Software

Programming Software

Typewrite

AutoCAD

Computer Networking

SPECIALIZED SKILLS for Jobsite or Workshop Positions

Check Skills / Equipment Operated

Forklift Operator

Sheet Metal Duct Fabricator

Class E Driver's License

Backhoe Operator

Duct Board Fabricator

Refrigerate Piping

Blueprint Reader

Pipe Fitter

A/C Controls

Welder

Plumber

A/C Service

Solder

CDL Driver's License

Electrician

ADDITIONAL VOLUNTARY INFORMATION

State any additional information you feel may be helpful to us in considering your application:

Background Information

Have You Ever Been Convicted of a Felony OR a first Degree Misdemeanor?

 Yes No

If 'YES', what charges?

Where convicted?

Date of conviction?

Have You Ever Plead Nolo Contendere OR Pled Guilty to a Crime which is a FEfelony OR a first degree Misdemeanor

 Yes No

If 'YES', what charges?

Where convicted?

Date of conviction?

NOTE: A 'YES' answer to these questions will not automatically bar you from employment. The nature, job, relatedness, severity and date of the offense in relation to the position for which you are applying are considered.

Citizenship

Are you a U.S. citizen OR are you legally authorized to work in the U.S.?

 Yes No

NOTE: Our company hires only U.S. citizens and lawfully authorized alien workers. If a conditional offer of employment is made, you will be required to provide proof of citizenship or authorization to work in the U.S.

Relatives

To your knowledge, Do you have any relatives working with our company?

 Yes No
Previous application OR employment

Have you ever filed an application with us before?

 Yes No

If yes give date:

Have you ever been employed with us before?

Yes No

If yes give date:
UNDERAGE ELIGIBILITY

Are you under 18 years of age?

Yes No

If yes, Can you provide proof of eligibility to work?

Yes No
APPLICANT'S STATEMENT

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 6 months. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an 'at will' nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this 'at will' employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

To accept the above statement, type in your name here:

Date:
Consumer Report Notification

You are hereby notified that a consumer report or an investigative consumer report may be obtained from a consumer reporting agency, or directly by this employer for the purpose of evaluating you for employment, promotion, retention, or reassignment as an employee.

The report may contain information bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living from public or private record sources or through personal interviews with your neighbors, friends, associates or educational facility.

Release Form For Consumer Reports

I, , understand that consumer reports or investigative consumer reports which may contain public record information may be requested or made on me including consumer credit, criminal records, driving record, education, prior employer verification, workers compensation claims and others. These reports will include experience along with reasons for termination of past employment. Further I understand that you may request information from various Federal, State, local and other agencies which contain my past activities.

In connection with this application for employment and any future promotions or reassignments, I hereby authorize without reservation, any party or agency contacted by ROBERT B. PAYNE, INC. to furnish the above mentioned information.

I further authorize ongoing procurement of the above mentioned reports at any time during my employment (or contract).

I have the right to make a request for information in files on me pending proper identification and the payment of any authorized fees.

I have read this document and understand it. Furthermore, I understand that I have the right to dispute inaccurate information with the Consumer Reporting Agency which has provided the disputable data. (The CRA must investigate the item--usually within 30 days--by presenting to its information source all relevant evidence submitted by me.) I understand that the CRA must give me a written report of the investigation, and a copy of my report if the investigation results in any change. If the CRA's investigation does not resolve the dispute, I have the right to add a brief statement to my file which must be included at least in summary in future reports. I also have the right to ask that anyone who has recently received my report be notified of the change.

Attention all job applicants:
During your personal interview you will be required to provide a certified copy of your motor vehicle report and a photocopy of your drivers license.

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"Just today I recommended R.B.P. yet again. You've been excellent on service for us & our problems. We are amazed and delighted."

Ken

Spotsylvania, VA

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