EMPLOYMENT

Position *
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Social Security Number *
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Name
First Name *

 
Last Name *


Address
Address Line 1 *

 
Address Line 2 *

 
City *

 
State *

 
ZIP / Postal Code *

 
Country *

Contact Info
Home Phone *

 
Alternate Phone *

 
Email *

Driver's License
Number *

 
State Issued *

 
Expiration Month *

 
Expiration Year *

More Info
Languages spoken fluently other than English

 
Are you a Veteran?

 
If Yes, Select
Special Disabled VeteranVietnam ETA VeteranOther
 
 
As an adult, have you ever been convicted for an offense other than a minor traffic violation? *

 
Your voluntary answers to this section will provide statistics needed to evaluate our recruitment program as well as prepare statistical reports required by Federal, State and County agencies. No decisions in the test process will be based on this section.
 
How did you find out about this job?
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Trade JournalRadioNewspaperNotification CardTVPhone RecordingInternetOther
 
 
Disability (Disabled)

 
Sex

 
Age Group

 
Do you have reliable transportation?

 
Do you have your I-9 (work status) information?

 
What is your desired pay rate?

 
What is your first date available?
Please check work skills for which you have experience.
Check one or more

CarpenterCrane OperatorMotor GraderFlaggers/Traffic ControlDOT Compliance MechanicRooferWelderCDL Truck DriverDozer OperatorPile DriverForm SetterHeavy Equipment MechanicSheet Rock FinisherSkilled Labor/Asphalt Div.Concrete FinisherCertified Fork Lift OperatorTrackhoe OperatorGrade CheckerBrick LayerSteel ErectorsSkilled Labor/Water & Sewer

 
List other experience that may apply

Education
Did you graduate from High School?

 
License and Certificates (State, Professional, Nursing, Trade, etc... which are required by this position) - Description, Issued by, Number, Expiration Date

Employment History
Resumes will not be accepted in place of a completed application. Complete all questions and respond to all requirements listed. Describe different positions held with the same employer. List relevant volunteer experience. List your most recent experience first.
 
Previous Employment
Company Name *

 
Address Line 1 *

 
Address Line 2 *

 
City *

 
State *

 
ZIP Code *

 
Phone Number *

 
Job title and description of duties *

 
Reasons for leaving *

 
Salary Amount *

 
Salary Type *

 
Hours worked per week *

 
Beginning Date *

 
Ending Date *

Previous Employment
Company Name

 
Address Line 1

 
Address Line 2

 
City

 
State

 
ZIP Code

 
Phone Number

 
Job title and description of duties

 
Reasons for leaving

 
Salary Amount

 
Salary Type

 
Hours worked per week

 
Beginning Date

 
Ending Date

Previous Employment
Company Name

 
Address Line 1

 
Address Line 2

 
City

 
State

 
ZIP Code

 
Phone Number

 
Job title and description of duties

 
Reasons for leaving

 
Salary Amount

 
Salary Type

 
Hours worked per week

 
Beginning Date

 
Ending Date

Previous Employment
Company Name

 
Address Line 1

 
Address Line 2

 
City

 
State

 
ZIP Code

 
Phone Number

 
Job title and description of duties

 
Reasons for leaving

 
Salary Amount

 
Salary Type

 
Hours worked per week

 
Beginning Date

 
Ending Date

Upload Resume
Optional - File: 2mb or less 'doc', 'docx', 'txt' or 'pdf'

 
Certification
I certify that all of the statements made on this application are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I understand that I may be fingerprinted and investigated prior to appointment.
I Agree *
 
 
I hereby give T.L. WALLACE CONSTRUCTION, INC. the right to make a thourough investigation of my past employment, education and activities and I release from all liability all persons, and companies, schools and corporations who suppliy such information. I indemnify T.L. WALLACE CONSTRUCTION, INC. against any liablilty, which might result from making such investigetion. I agree that T.L. WALLACE CONSTRUCTION, INC. may obtain a consumer report or other information regarding me and may consult others for my credit report. I understand that any false answer or statements or implications made by me in this application or other required documents shall be considered sufficient cause for denial of employment or discharge. Additionally, I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between T.L. WALLACE CONSTRUCTION, INC. and myself from either employment or for the providing of any benefit. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon T.L. WALLACE CONSTRUCTION, INC. unless made in writing. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and T.L. WALLACE CONSTRUCTION, INC. retains a similar right, with or without cause. I hereby certify that I have reviewed the foregoing information supplied by me and that to the best of my knowledge is true and complete. I hereby authorize a physician of T.L. WALLACE CONSTRUCTION, INC.'s choice to perform a physical examination and a urine drug screen test on me and to report these findings to the Personnel Department and/or all necessary persons. I also understand that T.L. WALLACE CONSTRUCTION, INC. will pay the initial expense of the physical and drug screen that is performed; however, I also understand that FIFTY DOLLARS ($50) will be withheld from my FIRST THREE (3) payroll checks for reimbursement of ONE HUNDRED FIFTY DOLLARS ($150) for the physical and drug screen. I understand that if I stay in the employment of T.L. WALLACE CONSTRUCTION, INC. for one (1) consecutive year, upon my request, the money withheld will be refunded. I also understand that this information is solely for the use of T.L. WALLACE CONSTRUCTION, INC. and will not be released to an other parties.
I Agree *
 
 
Additionally , I agree to submit to such urine, blood, saliva, or breath testing procedure in connection with and/or as part of a pre-employment examination. I additionally understand that the Company may refuse to hire me based upon or because of the results of any such urine, blood, saliva, or breathe test. I understand that I will be required to submit to a Post Accident, Random and Reasonable Suspicion drug screen and if I refuse, disciplinary action would be up to and including immediate termination. I hereby agree to abide by T.L. WALLACE CONSTRUCTION, INC.'s Drug and Alcohol rules and policy. I agree to submit to a drug and/or alcohol test at any time as a condition for my initial or continued employment. I authorize any laboratory or medical provider to release test results to T.L. WALLACE CONSTRUCTION, INC. I expressly authorize T.L. WALLACE CONSTRUCTION, INC. to release any test-related information, including positive results to T.L. WALLACE CONSTRUCTION, INC.'s Workers Compensation Carrier administration, Unemployment compensation Commission, or any other relevant government agency. I understand this agreement in no way limits my right to terminate my employment to be terminated in accordance with Federal and Sate Law. I understand that compliance with the Company's Drug and Alcohol Policy is a condition of employment with the Company. I understand that the disciplinary action that may be taken if I violate the policy (including any applicable policy, rule or regulation of any of the Company's clients or customer" in any manner may include discharge. I understand and agree to submit to all of the Company's policy requirements (including urine, blood, saliva or breath testing procedures for the detection of alcohol or drugs as defined by the policy, in my system as well as any and all searches and inspections which the Company may wish to perform or conduct).
I Agree *
 
Reference Services, Inc Disclosure
You must read the following document, check "I Agree", and fill out your name, initials, email, and date. This will count as your digital signature certifying that you have read and understand the document.
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Full Name *

 
Initials *

 
Email Address *

 
Date *

I Agree *