Employment Application

Step 1 of 2

Position(s) Applied For:*
Referral Source:*
- Advertisement
- Employee
- Walk-in
Name of employee referred by:*
First Last
Personal
Applicant Full Name:*
First Middle Last
Applicant Address:*
Street Address Address Line 2 City State ZIP Code
Email*
Applicant Phone:*
If necessary, may we contact you at work?*
- Yes
- No
Best time to contact you?*

: Hours

Minutes
Type of employment desired:*
- Full Time
- Part Time
- Temporary
- Seasonal
Date available for work:*
MM slash DD slash YYYY
Will you travel if the job requires it?*
- Yes
- No
Will you work over-time if the job requires it?*
- Yes
- No
Are you legally eligible for work in this country?*
- Yes
- No
Employment History
Please list your last 4 employers starting with the most recent. FURNISH ALL INFORMATION. Summarize the nature of the work performed and job responsibilities in the Job Summary section. You may disregard the job summary information ONLY if you are providing a resume. Explain any gaps in employment in comments section below.
Employer:*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title:*
Immediate Supervisor:*
First Last
May We Contact For Reference?*
- Yes
- No
- Later
Reason For Leaving:*
Date Employed From:*
MM slash DD slash YYYY
Date Employed To:*
MM slash DD slash YYYY
Compensation:*
Compensated Per:*
Add another employer?*
- Yes
- No
Employer:*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title:*
Immediate Supervisor:*
First Last
Supervisor's Title*
May We Contact For Reference?*
- Yes
- No
- Later
Reason For Leaving:*
Date Employed From:*
MM slash DD slash YYYY
Date Employed To:*
MM slash DD slash YYYY
Compensation:*
Compensated Per:*
Add third employer?*
- Yes
- No
Employer:*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title:*
Immediate Supervisor:*
First Last
Supervisor's Title*
May We Contact For Reference?*
- Yes
- No
- Later
Reason For Leaving:*
Date Employed From:*
MM slash DD slash YYYY
Date Employed To:*
MM slash DD slash YYYY
Compensation:*
Compensated Per:*
Add fourth employer?*
- Yes
- No
Employer:*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title:*
Immediate Supervisor:*
First Last
Supervisor's Title*
May We Contact For Reference?*
- Yes
- No
- Later
Reason For Leaving:*
Date Employed From:*
MM slash DD slash YYYY
Date Employed To:*
MM slash DD slash YYYY
Compensation:*
Compensated Per:*
Job Summary Information:*
Skills and Qualifications:
List any skills, foreign languages other than English, and qualifications acquired from employment or other experience.
References*
Name Telephone Years Known

Please list the name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three schools or personal references who are not related to you.
Educational Background*
School # of Years Degree GPA Major Minor

Please list last 3 schools attended, starting with the last.
Other
Organization Offices Held

List professional, trade, business or civic associations and offices held. (Exclude membership which would reveal sex, race, religion, national origin, age, ancestry or any other protected status.)
Optional Information:
List any special accomplishments, organizations or awards. (Exclude information which would reveal sex, race, religion, national origin, age, ancestry, handicap or other protected status.)
Agreement

It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/ or separation from the employer's service if I have been employed. I understand that just as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary.

I give Prime Construction Group, Inc. the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations and organizations for furnishing such information.

The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no questions on this application is used for the purpose of limiting or excluding any applicant's consideration for employment on a basis prohibited by local, state or federal law.
Signature*
Date*
MM slash DD slash YYYY

Phone or Email Employment Reference Check

Applicant Section

By signing the release below, I hereby authorize Prime Construction Group, Inc. to contact any and all former employers, and allow

_____________________________________________________________________________________

(Present or Former Company Name).

to release information about my background in reference to my employment record I release from all liability all persons, and companies, which provides such information. I indemnify Prime Construction Group, Inc. against any liability, which may result from making such requests. If employed this release shall remain in effect for the length of my employment. I believe to the best of my knowledge that all information I have provided is accurate, true and correct and that I fully understand the terms of this release.
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Fax
Signature*

Signature of Applicant

Employer Section

Record of Employment

Date(s) of Employment: ________________________________________________________________

Position(s) held: _______________________________________________________________________

Reason Employment Ended: ____________________________________________________________

Please rate the Applicant in each of the following areas:

Job Skill	Excellent	Good	Average	Below Avg.	Poor
Initiative	Excellent	Good	Average	Below Avg.	Poor
Attendance	Excellent	Good	Average	Below Avg.	Poor
Conduct	Excellent	Good	Average	Below Avg.	Poor
Attitude	Excellent	Good	Average	Below Avg.	Poor

Would you rehire Applicant? _____Yes _____No

__________________________________________________________________

Signature Title Date

Untitled
- First Choice
- Second Choice
- Third Choice

Name	Telephone	Years Known

School	# of Years	Degree	GPA	Major	Minor

Organization	Offices Held

Employment Application

Step 1 of 2

Personal

Employment History

Agreement

Phone or Email Employment Reference Check

Applicant Section

(Present or Former Company Name).

Employer Section

Record of Employment

__________________________________________________________________