EmailMe Form - Diboco Fire Sprinklers, Inc.

Date *

MM / DD / YYYY

Position(s) Applied For

How Did You Learn About Us?

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Personal Information

Phone Number *

### - ### - ####

Email *

Social Security #

If you are under 18 years of age, can you provide required proof of your eligibility to work? *

Yes

No

Have you ever filed an application with us before? *

Yes

No

If yes, Date

MM / DD / YYYY

Have you ever been employed with us before? *

Yes

No

If yes, Date

MM / DD / YYYY

Are you currently employed? *

Yes

No

May we contact your present employer?

Yes

No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Proof of citizenship or immigration status will be required upon employment.

Yes

No

On what date would you be available for work?

MM / DD / YYYY

Are you available to work: *

Are you currently on “lay-off” status and subject to recall?

Yes

No

Can you travel if a job requires it?

Yes

No

Have you been convicted of a felony within the last 7 years? Conviction will not necessarily disqualify an applicant from employment.

Yes

No

If Yes, please explain

EMPLOYMENT HISTORY:

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap or other protected status.

Employer:

Address:

Phone Number

### - ### - ####

Job Title:

Name and Title of Supervisor:

Start Date

MM / DD / YYYY

End Date

MM / DD / YYYY

Responsibilities:

Hourly Rate/Salary Starting to Final

Input hourly wage, if not salaried.

Reason for Leaving:

EMPLOYMENT HISTORY:

NEXT MOST RECENT EMPLOYMENT

Employer:

Address:

Phone Number

### - ### - ####

Position Title:

Name and Title of Supervisor:

Start Date

MM / DD / YYYY

End Date

MM / DD / YYYY

Responsibilities:

Hourly Rate/Salary Starting to Final

Input hourly wage, if not salaried.

Reason for Leaving:

OTHER EMPLOYMENT HISTORY WE SHOULD KNOW ABOUT:

Please type below

Special Skills and Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience. *

EDUCATION:

Name and Address Of School - Degree/Diploma - Graduation Date or Grade Completed. Describe any specialized training, apprenticeship, skills and extra-curricular activities, Honors or anything helpful to us in considering your application.

Do you have any pre-existing injury or physical limitation that could be aggravated by or interfere with your performance of the job you are being considered for? If so, please explain.

List professional, trade, business or civic activities and offices held.
You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, or handicap or other protected status:

Please enter 3 Work Related References:
Name/Title/ Address/ Phone *

Have you ever had any job-related training in the United State military?

Yes

No

If Yes, explain.

Are you physically or otherwise unable to perform the duties of the job for which you
are applying?

Yes

No

Emergency Contact Name *

First Last

Emergency Contact Phone Number *

### - ### - ####

Relationship

Emergency Contact Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

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 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at this 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.

Do you agree with the terms and conditions? *

Yes, I agree.

Initial *