Job Application

Application for employment - Applicant Information

***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 over 18?

In case of emergency, please notify

Have you been convicted of a felony or released from prison in the last 7 years?


Application for employment - Education Background

Select the highest grade completed from the options below

Grade School - High School

College


High School Information

Address

When

Grade

College Information

 

 

 

Trade/Business School

 

 

 


If you attended college, fill in this line

Application for employment - PJ&S Employment Background

Have you ever been employed by Paul Jackson & Son, INC.?

If so, who was your supervisor?

Do you have any family members working for PJ&S?

Application for employment - Job Selection

Job applying for

Type of employment desired: (SELECT ONE)

If hired - How soon could you start?

Do you have a valid driver's license?

Do you have personal transportation capable of getting to work?

Application for employment - Equipment Experience

List any equpment you are qualified to operate.

Note years/months you have operated this type of equipment.

Trucks

Forklift

Backhoe

Crane

Other

Can you read a tape measure?

Can you read blue prints?


Can you operate any of the below tools?

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 you feel is pertinent to work applied for:

Application for employment - Employment Background

List most recent employer from top to bottom.

Company Name & Info

Job Description

Dates & Salary Info

Does PJ&S have permission to call & verify information?


Company Name & Info

Job Description

Dates & Salary Info

Does PJ&S have permission to call & verify information?


Company Name & Info

Job Description

Dates & Salary Info

Does PJ&S have permission to call & verify information?

Application for employment - Personal References

List three personal references (other than relatives or employers)

Application for employment - Medical History

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

Phychiatric or Phychological

Hemophilia or any Blood Disease

Osteomyalitis

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:

Application for employment - Agreement

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:

***PLEASE NOTE THAT ENTIRE APPLICATION MUST BE FILLED OUT FOR CONSIDERATION - IF “NO” ANSWER APPLIES, PUT N/A IN BLANK. LEAVE NO BLANK SPACES. ***

Application for employment - Review

Applicant Information

EDIT SECTION

Education Background

EDIT SECTION

PJ&S Employment Background

EDIT SECTION

Job Selection

EDIT SECTION

Equipment Experience

EDIT SECTION

Employment Background

EDIT SECTION

Personal References

EDIT SECTION

Medical History

EDIT SECTION

Agreement

EDIT SECTION