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Non-CDL Application
Application for Employment
Position Applying For
Name
Street Address
City
State
Zip
Date of Birth
Phone
Other Phone
Emergency Contact
Are you eligible to work in the United States?
Yes
No
Are you 21 years of age or older?
Yes
No
Have you ever pled 'guilty' or 'no contest' to or been convicted of a crime?
Yes
No
If YES, please provide details
Have you ever been employed by Accell Construction, Inc?
Yes
No
If YES, dates of employment & reason for leaving
Are you related to any current Accell Construction, inc. employee?
Yes
No
If YES, their name & their relationship to you?
If required for position, do you have a valid driver's license?
Yes
No
If YES, State of Insurance, license #, and expiration date
How did you learn about this employment opportunity at Accell?
Will you work overtime if required?
Yes
No
Do you have dependable transportation?
Yes
No
Are you able to meet the attendance requirements of the position?
Yes
No
Are you willing to travel if the job requires it?
Yes
No
Education
Highschool Attended
City/State
Did you graduate?
Yes
No
If NO, # of years left to graduate?
If YES, date of graduation
Did you have to get a GED?
Yes
No
Other schools you attended and what degrees did you get?
College Attended
City/State
Did you graduate?
Yes
No
If NO, # of years left to graduate
If YES, date of graduation
Did you receive a degree and what was your major?
Other credentials / licenses / professional affiliations, etc., which are relevant to the job(s) for which you are applying. (Example: TWIC)
Please list any technical skills, trade skills, etc., relevant to this position. Include relevant equipment and tools, and note your level of proficiency (basic, intermediate, expert)
Dates Employed (Most Recent) From:
To
Title
Final Salary
Organization Name
Organization Address
Supervisor's Name
Title
Phone #
Primary Duties
Reason for Leaving
Dates Employed From
To
Title
Final Salary
Organization Name
Organization Address
Supervisor's Name
Title
Phone #
Primary Duties
Reason for Leaving
Dates Employed From
To
Title
Final Salary
Organization Name
Organization Address
Supervisor's Name
Title
Phone #
Primary Duties
Reason for Leaving
References
Name
Title
Relationship
Telephone
Years Known
Name
Title
Relationship
Telephone
Years Known
Name
Title
Relationship
Telephone
Years Known
PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.
I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.
I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.
I understand that this application remains current for only 30 days. At the conclusion of that time if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time with or without cause and without prior notice and the employer reserves the same right to terminate my employment at any time with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered.
Applicant Signature
Date
Submit
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