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Full Name:*
Email*
Phone*

Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth
Date Format: MM slash DD slash YYYY
Date of Application
Date Format: MM slash DD slash YYYY
Email
Phone
How did you hear about us?
Desired Wage/Hour
Are you atleast 18 years old?
- Yes
- No
Position applied for

Personal References (Please list 3 personal references)
Name Relationship Phone Number
Do you have reliable transportation to get to work?
- Yes
- No
Do you have your own hand tools?
- Yes
- No
Are you willing to work overtime when required?
- Yes
- No
Are you able to work on weekends on occassion?
- Yes
- No
Are you able to work evening or night hours on occassion?
- Yes
- No
Can you climb ladders?
- Yes
- No
Can you setup and move a 32' extension ladder (up to 75 lbs) by yourslef?
- Yes
- No

Employment History: List last 5 years experience starting with the most recent. All information must be completed.
Employed From Employer Name Position Held Supervisor Name Employment Until Employer Address Employer Phone Starting Salary Ending Salary Job Title & Duties Reason for Leaving
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The above information is true and correct. I understand that, in the event of my employment by the Company, I shall be subject to dismissal if any information that I have given in this application is false or misleading, or if I have failed to give any information herein requested regardless of the time elapsed after discovery. I authorize the company to inquire into my educational, professional and past employment history references as needed to research my qualifications for this position. I hereby give my consent to any former employer to provide employment-related information about me to the Company and will hold the Company and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information. I further authorize Company to obtain any credit and consumer check as well as criminal background check. I understand that nothing in this employment application, the granting of an interview or my subsequent employment with the Company is intended to create an employment contract with myself and the Company under which my employment could be terminated only for cause. On the contrary, I understand and agree that, if hired, my employment will be terminable at will and may be terminated by the Company or me at any time and for any reason. I understand that no person has any authority to enter into any agreement contrary to the foregoing. If employed, I will be required to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for completion of Form I-9.*
- I hereby acknowledge that I have read and agree to the above statements.
NO DRUG USE POLICY: This company does not hire persons who use illegal drugs. All persons seeking employment or employed with Company may be required to take and pass a screen for illegal drugs, and may be subject to periodic screening for illegal drugs. I hereby voluntarily consent to provide a urine specimen (or a blood specimen as required for alcohol) at a collection facility designated by this Company and further consent to have the specimen examined at a laboratory designated by this Company. An employment physical test and fit test will be required, also at a facility designated by this Company. I hereby certify that I do not use illegal drugs.*
- I hereby certify that I do not use illegal drugs.
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Employed From	Employer Name	Position Held	Supervisor Name	Employment Until	Employer Address	Employer Phone	Starting Salary	Ending Salary	Job Title & Duties	Reason for Leaving

Name	Relationship	Phone Number

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