Application Download
***PLEASE NOTE THAT ENTIRE APPLICATION MUST BE FILLED OUT FOR CONSIDERATION - IF “NO” ANSWER APPLIES, PUT N/A IN BLANK. LEAVE NO BLANK SPACES. ***
Are you a U.S. Citizen or approved to work in the US?
No Yes
Are you over 18?
Have you been convicted of a felony?
Have you been released from prison in the last 7 years?
If Yes, State Details and charges
In case of emergency, please notify
High School Name
Location (City, State)
Year Graduated
Grade Completed
College Name
Degree Earned
College Major:
Trade School
Certification Earned
Field of Trade:
Have you ever been employed by Paul Jackson & Son, INC.?
If so, who was your supervisor?
Reason for leaving:
Do you have any family members working for Paul Jackson & Son, INC.?
If yes, who?
List three personal references (other than relatives or employers)
1st Position Applying For:
Salary Desired:
Location Preferred:
Date Available:
2nd Position Applying For:
Type of employment desired: (SELECT ONE)
Full Time Part Time Summer Help Temporary
If hired - When can you start?
Do you have a valid driver's license?
Do you have a reliable personal transportation?
Yes No
If not, how would you get to work?
List any equipment you are qualified to operate:Years Experience
Truck
Backhoe
Forklift
Crane
Other:
Can you read a tape measure?
Can you read blue prints?
If Yes
Well Average Some, but not well.
Can you effectively operate the following:
Circular Saw?
Rotary Hammer?
Drill?
Tamp?
Shovel?
Table Saw?
Pick?
Maul?
Nail Gun?
Screw Gun?
Router
List any other tools you can effectively operate:
List any other information or skills you feel are pertinent:
Most Recent Employer:
Company Name & Info
Job Description:
Dates & Salary Info
Does Paul Jackson & Sons have permission to contact this company?
If no, give reason
Next Most Recent Employer:
Health Questionnaire
Medical History
The type of work you are applying for could be physical in nature. PJ&S does not want to put you in a situation that could harm you or aggravate your ailment. Do you have or have you ever had any of the following?
Please check EACH of the following items YES or NO. Please list details to any item answered YES on the space supplied below. You must answer ALL QUESTIONS!
Epilepsy
Diabetes
Cardiac (Heart)
Knee Problems
Any Loss of Vision
Polio
Any Amputation
Cerebral Palsy
Multiple Sclerosis
Parkinson's Disease
Vascular Disorders
Foot Problems
Hand Problems
Back Problems
Psychiatric or Psychological
Hemophilia or any Blood Disease
Osteomyelitis
Stiff Joints
Hypoglycemia
Muscular Dystrophy
Shoulder Problems
Herniated Disk
Back Surgery
Allergies
Breathing Disorders
Leg Problems
Arm Problems
Neck Problems
Please list ANY disorder or ailment you have or have had in the past that is not listed above:
Please list ANY task that a doctor has stated you shouldn't be doing or would restrict your ability to do any construction task assigned to you:
Explain any answer to any item above marked YES:
READ THE FOLLOWING STATEMENT AND SIGN BELOW
I have not been and am not now a member of any organization which advocates the forceful overthrow of the U.S. Government.
I also state that I am a legal citizen of the United States of America.
If not a legal citizen, I hereby state that I am in the United States of America legally and if hired will supply PJ&S copies of papers showing that I am legally in the United States of America. I also agree that, if hired, I will notify PJ&S immediately when this legal status changes.
I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision.
I hereby authorize Employers, Schools, Doctors, Hospitals or Persons to give any information regarding me in responding to inquiries in connection with my application. Upon my written request, within a reasonable time, additional disclosure concerning the nature and scope of the information requested will be provided.
I understand that misrepresentation or omission of the facts called for herein will be sufficient cause for cancellation of the application and/or for termination from the Company's service if I have been employed. I also understand that employment is subject to a satisfactory physical examination, including taking a drug test if requested, by a physician if PJ&S deems necessary.
I hereby acknowledge that any action, damage and liability caused by the misrepresentation or omission of any requested information on this application will be the applicant's responsibility. PJ&S will be reimbursed by the applicant for any cost due to misrepresentation of the facts by the applicant.
SIGNATURE OF APPLICANT:
TODAY'S DATE:
Applicant Information
Education Background
PJ&S Employment Background
Job Selection
Equipment Experience
Employment Background
Personal References
Agreement
