Employment Application

* Note: This application is valid for 60 days. If you wish to be considered for employment after 60 days, a new application must be completed.

Personal Information


Today's Date

First Name * Last Name *

Social Security Number

Present Address:

Street City
State Zip

Permanent Address:

Street City
State Zip

Phone Number

Are you 18 years or older?  Yes No

Email Address

Employment Desired


Position Desired Date you can start:
Salary Desired

Are you currently employed?  Yes No
If so, may we inquire of your present employer?

Have you ever applied to this company before?  Yes No
If so, where? When?

Have you worked for this company before?  Yes No
If so, where? When?

Education


High School

Name of school Location
No. of years attended Did you graduate?  Yes No

College

Name of school Location
No. of years attended Did you graduate?  Yes No
Subject studied

Trade or Business

Name of school Location
No. of years attended Did you graduate?  Yes No
Subject studied

Other subjects of special study, training or research work:

Former Employers


List last 4, starting with most recent. *Application will not be reviewed if this section is left blank.

1

Worked from to
Employer Name Address
Position held
Supervisor Name Phone
Salary Reason for leaving

2

Worked from to
Employer Name Address
Position held
Supervisor Name Phone
Salary Reason for leaving

3

Worked from to
Employer Name Address
Position held
Supervisor Name Phone
Salary Reason for leaving

4

Worked from to
Employer Name Address
Position held
Supervisor Name Phone
Salary Reason for leaving

General


How did you hear about GBA, inc.?

Military Service? Are you presently in National Guard or Reserves?  Yes No

Do you have a valid driver's license?  Yes No Do you have a Commercial Driver's License?  Yes No
If yes, Class & Number

Have you ever been convicted of a crime, other than minor driving offenses?  Yes No
If so, please explain:

NOTE: A prior conviction will not necessarily bar you from employment, however, the type of conviction and when it occurred will be considered.

References


Please provide 3 persons, not related to you, whom you have known at least one year.

Name Address
Phone Years Acquainted

Name Address
Phone Years Acquainted

Name Address
Phone Years Acquainted

IN CASE OF EMERGENCY, notify:
Name Relationship
Phone Address

General Questions


Check which statement best describes you.

1. Are you...
 Detail Oriented Big Picture Oriented

2. Would you rather...
 Think up a plan Work out the details of a plan Supervise the work Do the work

3. Do you work best...
 Alone As a member of a team As a coordinator of a team

4. Do you have any prior training in any of the following? (Check all that apply)
 CPR/AED First Aid OSHA 10 OSHA 30 Forklift Operator Certification
Other certifications:

Skills Inventory Checklist


On the following questions, please rate your experience with the crafts and equipment listed. The more information we have, the better. You do not need to include anything you feel violates your privacy or security in any way.

Please rate your experience on the following (1 being the least, 10 being the most)

1. Carpentry (rough): 110
2. Carpentry (finish): 110
3. Plumbing: 110
4. Electrical: 110
5. Drywall: 110
6. Painting: 110
7. Concrete/masonry: 110
8. Roofing: 110
9. Laborer: 110

Do you possess tools of your trade?  Yes No
List the tools you possess that are related to your trade:

List your experience with the following equipment:

Backhoe
Size Make
Type Years Experience

Skid Steer
Size Make
Type Years Experience

Track Excavator
Size Make
Type Years Experience

Truck Driver
Size Make
Type Years Experience

Scraper
Size Make
Type Years Experience

Front End Loader
Size Make
Type Years Experience

Road Grader/Blade
Size Make
Type Years Experience

Compactor/Roller
Size Make
Type Years Experience

Other:
Size Make
Type Years Experience

Certification


I certify that the information in this application is true and understand that any misrepresentations or false or omitted facts may result in my termination, regardless of the time of discovery by the company. I also understand that, if hired, my employment is for no definite period and may be terminated at any time without written notice and that, absent a written contract signed by the President, of the Company, I will remain an at-will employee and can be terminated any time without notice.

I authorize investigation of the statements herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information such references may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand that if the Company decides to engage an investigative consumer reporting agency to report on my credit and personal history, the Company will provide me, at my request, with the name and address of the agency so that I can obtain from them the nature and substance of the information contained in the report.

By entering my full name here, and clicking "Submit Application," I accept and agree to the above terms.
Type full name to sign:
Enter the correct answer to validate your application: