Applicant Information

Address:

Contact Information

Phone Number*:

Email*:

Have you ever been employed here before?
YesNo

Are you legally eligible for employment in the United States?
YesNo

Have you been convicted of a crime within the last 7 years?
YesNo
If yes, please provide a brief description. Conviction is not necessarily a bar to employment. Each instance and explanation will be considered in relation to the position for which you are applying.

Do you have a valid driver’s license?
YesNo

Do you have transportation to travel to and from work?
YesNo

Employment History

Provide the following information from your past four (4) employers, assignments, or volunteer activities. Begin with the most recent.
I have no previous employment history.

Supervisor Name and Title*:

Supervisor Phone Number*:

Date Worked*:


Reason for Leaving*:

Supervisor Name and Title*:

Supervisor Phone Number*:

Date Worked*:


Reason for Leaving*:

Supervisor Name and Title*:

Supervisor Phone Number*:

Date Worked*:


Reason for Leaving*:

Skills, Qualifications, and Experience

Licenses or Certificates (Please List all that apply):
No Applicable Licenses or Certificates
Job Specific Skills (Please List):
No Applicable Skills
Job Specific Training (Provide a brief description):

Please summarize any training or skills that you possess that may qualify you as being able to conduct the job-related functions in which you are applying for.

No Applicable Training

What equipment do you have experience with? Please check all the following that apply.
BrushRollerClimbing LaddersScissor LiftSand BlastingPaint SprayerTexture Sprayer

Are you able to climb ladders?
YesNo

Are you able to lift up to 75 lb?
YesNo

Education

High School

Name and location:

Years completed:

Did you graduate?
YesNo

Other

Trade School:

GED:

Please explain:

Reference 1

Name:

Phone Number:

Years Known:

Reference 2

Name:

Phone Number:

Years Known:

Reference 3

Name:

Phone Number:

Years Known: