Employment Application

APPLICANT INFORMATION

Applicant Name:

Address:

City:

State:
—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zipcode:

Phone Number:

Email Address:

Date of Application:

EMERGENCY CONTACT

Contact Name:

Relationship to you:

Address

City

State
—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zipcode

Telephone

EMPLOYMENT POSITION

—Please choose an option—Project managerConstruction WorkerElectricianProject engineeringHeavy equipment operatorManagementWorkerCarpenterArchitectPlumberHuman Resources ManagerSuperintendentEstimatorRoofersSupervisorConstruction Foreman

Full or Part Time:
Full TimePart Time

When can you begin work if you are hired?

Salary Desired:
HourlyMonthlyYearly

Have you applied to any position at our company previously?
YesNo

If yes, when did you apply:

If yes, what position did you apply for:

Did anyone refer you to our company? If yes, who:

Do you have any friends or family working at our company?
YesNo

If yes, name:

How did you hear about this position?

WORK ELIGIBILITY

Are you at least 18 years old?
YesNo

If offered employment, are you able to provide proof that you are legally eligible to work in the
United States?YesNo

Are you able to perform the essential functions of the job position with or without reasonable
accommodation?
YesNo

EDUCATIONAL BACKGROUND

Please list the schools attended. Include any other pertinent information about your education and training.

School Name:

Address:

From:

To:

Did you graduate?YesNo

Subjects studied:

College/University:

Address:

From:

To:

Did you graduate?YesNo

Degree Received:

Other:

Address:

From:

To:

Did you graduate?YesNo

Degree Received:

Professional licenses, qualifications, or certifications:

Special Achievements or Awards:

EMPLOYMENT HISTORY

Please list all jobs. Begin with the current or most recent employment. Continue on an extra sheet of paper if necessary.

Name of Employer:

Address:

From:

To:

Key Duties:

Reason for Leaving:

Supervisor Name:

Supervisor Phone

Name of Employer:

Address:

From:

To:

Key Duties:

Reason for Leaving:

Supervisor Name:

Supervisor Phone

Name of Employer:

Address:

From:

To:

Key Duties:

Reason for Leaving:

Supervisor Name:

Supervisor Phone:

APPLICANT SKILLS

Skill:

LowMediumHigh

Skill:

LowMediumHigh

Skill:

LowMediumHigh

Language

FluentGoodFair

Other Skills:

REFERENCES

Name:

Relationship:

Address:

Telephone:

Name:

Relationship:

Address:

Telephone:

I certify that all statements given on this application are true and complete to the best of my knowledge. I understand that any statements found to be false or misleading give sufficient reason not to hire me, or if hired, can be grounds for immediate termination. I authorize DMC Home Improvements, LLC to conduct any investigation deemed appropriate concerning my application.

I authorize former employers, references, and all other individuals and organizations disclosed herein to provide any information sought in connection with this application.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.