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Welcome to DRL Construction Inc.
Employment


PLEASE FILL OUT THE FORM BELOW AND SUBMIT
POSITION APPLIED FOR DATE:  (yyyy/mm/dd)
PERSONAL DATA
First Name
Middle Name
Last Name
Social Security Number
Email Address
Street Address
City
State
Zip Code
Telephone Number
When will you be available to start work?
Are you atleast 18 years old?
Yes No
If not, state your age for child labour law purposes only
Are there any days, shifts or hours you will not work?
Please explain:
Are you available for out of town work?
Yes No
Will you work overtime, if required?
Yes No
Are you legally authorized to work in the United States?
Yes No
Will you now or in the future require sponsorship
for employment visa status?
Yes No
Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?
Yes No
Date of conviction:  (yyyy/mm/dd)
If yes, please explain
Have you been named as a defendant in a civil
action for an intentional tort?
Yes No
If yes, please describe the nature of the tort and the disposition of the action
(Answering "yes" to these questions does not constitute an automatic bar to employment. Factors such as date of the incident, seriousness and nature of the violation, rehabilitation and positon applied for will be taken into account.)
Have you taken any illegal drugs within the last 30 days?
Yes No
If yes, please explain:
How did you learn of our company?
    Newspaper Friend
    Recruiting Firm Current Employee
    Other    
If a referral, who were you referred by?
Have you ever applied or worked here before?
Yes No
 
If yes, provide dates  (yyyy/mm/dd)  
DRIVING RECORD
(Answer only if driving is a requirement for the job for which you are applying)
Do you have a valid drivers license?
Yes No
License No.
Have you had any tickets?
yes No
If yes, please explain
Has your license ever been suspended or revoked
Yes No
If yes, please explain
Do you have any DUI of DWI convictions?
Yes No
If yes, please state when you were convicted and explain
 

EMPLOYMENT HISTORY
Company Name:
Address:
Tel #:( )
Name fo Supervisor:
May We Contact:
Yes No
 
Dates Employed From:
(yyyy/mm/dd)		 To:
(yyyy/mm/dd)
Rate of Pay : Start: Last:
State job titles and describe job duties:
Reason for Leaving:


Company Name:
Address:
Tel #:( )
Name fo Supervisor:
May We Contact:
Yes No
 
Dates Employed From:
(yyyy/mm/dd)		 To:
(yyyy/mm/dd)
Rate of Pay : Start: Last:
State job titles and describe job duties:
Reason for Leaving:


Company Name:
Address:
Tel #:( )
Name fo Supervisor:
May We Contact:
Yes No
 
Dates Employed From:
(yyyy/mm/dd)		 To:
(yyyy/mm/dd)
Rate of Pay : Start: Last:
State job titles and describe job duties:
Reason for Leaving:


Company Name:
Address:
Tel #:( )
Name fo Supervisor:
May We Contact:
Yes No
 
Dates Employed From:
(yyyy/mm/dd)		 To:
(yyyy/mm/dd)
Rate of Pay : Start: Last:
State job titles and describe job duties:
Reason for Leaving:
Please emplain any gaps in your employment history
Have you ever been descharged or forced to resign?
If yes, please explain
Have you received any disciplinary counseling in the last twelve months of employment?
If yes, please explain
Were you give a performance review within the last 12 months of active employments ?
If yes, what was the range of scores used and what was your score?
Have you signed any non-compete, non-solicitation, or other agreement that might prevent you from working for this company or limit the services you are able to provide ?
If yes, please explain
EDUCATION AND PROFESSIONAL AFFILIATIONS
(May or may not be cnsiderded depending on job applied for. You need not disciose membership in prpfessional organizations that may reveal information regarding race , color, creed, sex, religion, national origin,age,disability, mariatal status, or any other protected status)
APPLICANT'S ACKNOWLEDGEMENT

I certify that the answer given herein are true and complete to the best of my knowledge. I understand that any misrepresentations, omissions of facts or incomplete answers in any application document will disqualify me from further considerations of employment. I further understand that, if employed, any misrepresentations or omissions of facts in any application document will be cause for my dsmissal at any time without prior notice.

I understand that, if employed my employment with the Employer is not for a specific term and may be terminated by me or the Employer with or wothout notice or cause at any time. I further understand that no oral promise, employer polioy, custom, budiness practice or ohter procedure (including the Employee Handbook or any oher personnel manual) constitutes an employment contract or modification of the at-will employemnt relationship between me and the Employer.

I understand that applicants for certain positions may be required to quality for employment based on additional employment criteria. For example, I may be required to take job-related tests; take a driver's examination, submit to a background investigation; of take a pre-employment drug test. If I am offered employment to start work before any required test is completde, my employment is contingent on a satisfactory result on all required tests. I authorize the company to contact my prior employers, and other
sources of information regarding my background, and I hereby authorize and direct each such employer and source of information to answer any and all questions regarding my prior employment and background. I hereby indemnify the company, Professional Imployer Plans, each of my prior employers, and each of the other sources of information contacted and agree to hold them harmless from any claims arising from this authorization and direction or from any disclosures made in response to inquiries made pursuant to this authouruzation and direction.

I understand that this application will be considered active for 30-calendar days from this date. In I have not heard from the company at the conclusion fo the 30-calendar day period, it is my responsibility to complete a ne application if I wish to be considered for employment.
Signature : Date: (yyyy/mm/dd)
 
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