2014-Application for Employment

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Employment Application

Applicant Information

Full Name:Last First M.I. Date:

Address:Street Address Apartment/Unit #

City State ZIP Code Social Security No

Phone: Email:

Years Experiences: Date Available: Desired Salary: $

Are you at least 18?

YES NO

Are you a citizen of the United States?

YES NO

If no, are you authorized to work in the

YES NO

Have you ever worked for this companyYES NO

If yes, when

Have you ever been convicted of a felony?

YES NO

If yes, explain

Education

High School: Address:

From: o:

Did you

graduate?

YES NO

Diploma:

College: Address:

Position Applied:

Referred By:

Wright Gregory J Aug 10, 1987

5305 Poplar Valley Ct

Centreville VA 20772 220-19-0864

240-398-6472 [email protected]

Apprentice

0 ASAP 17

Frederick Douglass 3330 Croom Road

2001 2005

Frostburg Cumberland , Md


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General Information

Are you a Certified Journeyman? YES No

Special Training or Certification:

Subject Of Special Study or Research:

Military Service: YES No Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

Do you understand you are required to provide tools in compliance with the company tool list and job

requirements?

YES No

Do you understand that you must provide your own transportation to jobsite? Jobsites are in Northern VA, DC,

MD, WV

YES No

Are you willing to work alternative shifts?YES No

Are you willing to work overtime?YES No

Have you supervised others before? How many? YES No

Do you understand the ability to work well with your co-workers is a job requirement throughout your

employment?

YES No

Do you understand that you are expected to work equally well with people of other races, ethnic groups,

religious or gender?

YES No

Do you have a valid driver license? YES No

Do you have a good driving record?YES No

Do you understand that you are required to follow OSHA Safety practice without fail?

YES No

8


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Previous EmploymentStart with most recent employer

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary:$ Ending Salary:$

Responsibilities:

From: To: Reason for Leaving

May we contact your previous supervisor for a reference?

YES NO

Company: Phone:


Job Title: Starting Salary:$ Ending Salary:$

Responsibilities:

From: To: Reason for Leaving

May we contact your previous supervisor for a reference?

YES NO

Company: Phone:


Job Title: Starting Salary: $ Ending Salary: $

Your Health Magazine 336-392-9945

1330 little river turnpike Annandale, VA Sarah

Account manager 12

customer service, cold calling, sales

12

1-2014 3-2014 Moved away

Muddy Mutt 703-580-4499

2234 South Oxford st Arlington, Va Andrew Lowe

Manager 12 12

Cleaning, Cashier, Customer Service,

8-2013 1-2014 Moved away to centreville


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ReferencesPlease list three references

Full Name: Relationship:

Company: Phone:

Address: Years Known:


Company: Phone:



Company: Phone:


Disclaimer and Signature

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this

application from all previous employers, educational institutions, and references. I also hereby release from liability thepotential employer and its representatives for seeking, gathering, and using such information to make employment decisions

and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for

cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by American

with Disabilities Act (ADA) and other relevant federal and state laws.

If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute

an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or

without cause, at any time, so long as there is no violation of applicable federal or state law.

We are an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to

race, color, religion, gender, sexual orientation, national origin, citizenship, age, height, weight, or disability. We assure you that

Leila Rashidi friend

Law office of Brian Murry 703-203-4304

2

Renee Shamberger co-worker

Muddy Mutt 301-526-3249

7+

Shaynah Williams co workerMuddy Mutt 202-569-0277

7+


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Equal Employment Opportunity Commission

Voluntary Questionnaire

The Equal Employment Opportunity Commission (EEOC) requires organizations with 100 or more employeesto complete an EEO-1 report each year. Completion of this ata is !oluntary an will not affect your

opportunity for employment or terms or conitions of employment. This form will "e use for EEO-1 reportingpurposes only an will "e #ept separate from all other personnel recors only accesse "y $uman %esources&epartment. 'lease return complete forms to the $uman %esources &epartment.

Name

Job Title

GENDER:

('lease chec# one of the options "elow) *ale +emale

RACE/ETHNICITY:('lease chec# one of the escriptions "elow corresponing to the ethnic group with which you ientify.)

Hispanic or Latino, person of Cu"an *eican 'uerto %ican /outh or Central ,merican or other/panish culture or origin regarless of race.

White Not Hispanic or Latino!, person ha!ing origins in any of the original peoples of Europe the*ile East or orth ,frica.

"lac# or A$rican American Not Hispanic or Latino!, person ha!ing origins in any of the "lac# racialgroups of ,frica.

Nati%e Ha&aiian or 'ther (aci$ic Islan)er Not Hispanic or Latino!, person ha!ing origins in anyof the peoples of $awaii uam /amoa or other 'acific 2slans.

Asian Not Hispanic or Latino!, person ha!ing origins in any of the original peoples of the +ar East/outheast ,sia or the 2nian /u"continent incluing for eample Cam"oia China 2nia 3apan 4orea*alaysia 'a#istan the 'hilippine 2slans Thailan an 5ietnam.

American In)ian or Alas#a Nati%e Not Hispanic or Latino!, person ha!ing origins in any of the

original peoples of orth an /outh ,merica (incluing Central ,merica) an who maintain tri"al affiliation orcommunity attachment.

T&o or *ore Races Not Hispanic or Latino!,ll persons who ientify with more than one of thea"o!e fi!e races.

Date complete)

Greg Wright

Apprentice

3-19-2014


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Este empleador le proporcionar a la Administracin del Seguro

Social (SSA), y si es necesario, al Departamento de Seguridad

Nacional (DHS), informacin obtenida

del Formulario I-9 correspondiente a

cada empleado recin contratado con el

propsito de confirmar la autorizacin de

trabajo.

IMPORTANTE: En dado caso que el gobierno

no pueda confirmar si est usted autorizado

para trabajar, este empleador est obligado

a proporcionarle las instrucciones por escrito

y darle la oportunidad a que se ponga en

contacto con la oficina del SSA y, o el DHS

antes de tomar una determinacin adversa

en contra suya, inclusive despedirlo.

restringir o influenciar la seleccin de los documentos que sean

presentados para ser utilizados en el Formulario I-9.

A fin de poder determinar si la

documentacin del Formulario I-9 es

valida o no, este empleador utiliza la

herramienta de seleccin fotogrfica de

E-Verify para comparar la fotografa que

aparece en algunas de las tarjetas de

residente y autorizaciones de empleo, con

las fotografas oficiales del Servicio de

Inmigracin y Ciudadana de los Estados

Unidos (USCIS).

Si usted cree que su empleador ha violado

sus responsabilidades bajo este programa,

A V I S O:

La Ley Federal le exige a

todos los empleadores

que verifiquen la identidad y

elegibilidad de empleode toda persona contratada

para trabajar en

los Estados Unidos.

Participa en E-Verify

Este Empleador


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IF YOU HAVE THE RIGHT TO WORK,

Dont let anyone take it away.

If you have a legal right towork in the United States,

there are laws to protectyou against discriminationin the workplace.

You should know that

No employer can deny youa job or re you becauseof your national origin orcitizenship status.

In most cases employerscannot require you to be aU.S. citizen or permanentresident or refuse anylegally acceptabledocuments.

If any of these things havehappened to you, you may

have a valid charge ofdiscrimination that can beled with the OSC. Contactthe OSC for assistance inyour own language.

Call 1-800-255-7688. TDDfor the hearing impaired is

1-800-237-2515.

In the Washington, D.C.,area, please call202-616-5594, TDD202-616-5525

Or write to:U.S. Department of JusticeOffice of Special Counsel - NYA950 Pennsylvania Ave., N.W.Washington, DC 20530

U.S. Department of JusticeCivil Rights Division

Office of Special Counsel forImmigration-Related UnfairEmployment Practices


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SI USTED TIENE DERECHO A TRABAJAR,

no deje que nadie se lo quite.

Si tiene derecho a trabajarlegalmente en los Estados

Unidos, existen leyespara protegerlo contrala discriminacin en eltrabajo.

Debe saber que -

Ningn patrn puedenegarle trabajo, ni puededespedirlo, debido a su pasde origen o su condicin deinmigrante.

En la mayora de los casos,los patrones no puedenexigir que usted seaciudadano de los EstadosUnidos o residente permanente o negarse a aceptardocumentos validos por ley.

Si se ha encontrado encualquiera de estas

situaciones, usted podratener una queja valida dediscriminacin.Comunquese con la Ocinadel Consejero Especial (OSC)de Practicas Injustas en elEmpleo Relacionadas a laCondicin de Inmigrantepara obtener ayuda enespaol.

Llame al 1-800-255-7688; TDDpara personas con problemas

de audicin: 1-800-237-2515.En Washington, DC, llame al(202) 616-5594: TDD parapersonas con problemas deaudicin: (202) 616-5525. Oescrbale a OSC a lasiguiente direccin:

U.S. Department of JusticeOffice of Special Counsel - NYA950 Pennsylvania Ave., N.W.Washington, DC 20530

Departamento de Justiciade los Estados Unidos,

Divisin de DerechosCiviles

Oficina del Consejero Especial

2014-Application for Employment

Documents

Transcript of 2014-Application for Employment