Employment Application

Name *

First

Middle

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Length of time at this address *

Position applying for *

This field must be filled in, even if you've checked one of the positions above.

Job(s) applying for (Positions Currently Available): *

Steel
Metal Buildings
General Trades
BIM Coordinator

Do you want to work *

Full-Time
Part-Time

Are you 18 years of age or older? *

Yes
No

Are you legally permitted to work in the US? *

Yes
No

Desired salary

Previous Employment

Please list your last three employers and dates of employment

Company name *

Employer #1

Position *

Employer #1

From date *

Employer #1

To date *

Employer #1

Supervisor *

Employer #1

Phone *

Employer #1

May we contact? *

Yes
No

Employer #1

Company name

Employer #2

Position

Employer #2

From date

Employer #2

To date

Employer #2

Supervisor

Employer #2

Phone

Employer #2

May we contact?

Yes
No

Employer #2

Company name

Employer #3

Position

Employer #3

From date

Employer #3

To date

Employer #3

Supervisor

Employer #3

Phone

Employer #3

May we contact?

Yes
No

Employer #3

If applying only for part-time, what days and hours?

Are you employed now? *

Yes
No

If yes to the above, may we contact your employer? *

Yes
No

Have you ever applied for work with us before? *

Yes
No

If yes to the above, please explain?

List anyone you know who works for us:

Did anyone refer you to us? *

Yes
No

If yes to the above, who referred you?

Why are you interested in working for this organization?

Construction Experience (Describe the type of construction work you have done in the past)

U.S. Armed Forces Service?

Yes
No

Branch of Service

Duties

Rank or rating at time of enlistment

Rating at time of discharge

Were you dishonorably discharged?

Yes
No

Are you able to do the essential functions for the job(s) for which you are applying? *

Yes
No

If no to the above, please identify the applicable function:

How much time have you lost from work or school during the past two calendar years FOR REASONS OTHER THAN VACATION AND HOLIDAYS? (copy)

Year (1)

Number of Days (1)

Year (2)

Number of Days (2)

Do you have any activities, commitments, or responsibilities (for example car-pooling, school, other employment) which might in any way restrict the hours (including overtime) or days you can work? *

Yes
No

No Restrictions on Employment Hours or Overtime? *

Yes
No

Have you ever been fired? *

Yes
No

If yes to the above, why: *

What career accomplishments are you most proud of?

HAVE YOU BEEN CONVICTED OF A FELONY? You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied) *

Yes
No

If yes to the above, explain when, where, and the nature of the offense: *

Are there any felony charges pending against you now? *

Yes
No

If yes to the above, describe: *

Are you authorized to work in the United States? *

Yes
No

Do you have a reliable means of transportation? *

Yes
No

If hired, when can you start? *

Education

Number of Years Attended *

High School / GED

Name of School *

High School / GED

City, State *

High School / GED

Course *

High School / GED

Did you graduate? *

Yes
No

High School / GED

Number of Years Attended

College

Name of School

College

City, State

College

Course

College

Did you graduate?

Yes
No

College

Number of Years Attended

Other

Name of School

Other

City, State

Other

Course

Other

Did you graduate?

Yes
No

Other

Business References

Please list 2 Business and 2 Personal. (NOTE: for Business, list only those persons who held managerial positions during the time of your employment.)

Name *

Reference Business 1

Telephone Number *

Reference Business 1

Title *

Reference Business 1

Company *

Reference Business 1

Name

Reference Business 2

Telephone Number

Reference Business 2

Title

Reference Business 2

Company

Reference Business 2

Name *

Reference Personal 1

Telephone Number *

Reference Personal 1

Title *

Reference Personal 1

Company *

Reference Personal 1

Name

Reference Personal 2

Telephone Number

Reference Personal 2

Title

Reference Personal 2

Company

Reference Personal 2

APPLICANT'S CERTIFICATION AND AGREEMENT

PLEASE READ CAREFULLY:

1. Certification of Truthfulness.

I certify that all statements on this Application for Employment are complete and truthful and agree that such statements may be investigated and if found to be false will be sufficient reason for not being employed, or if employed may result in my dismissal.

2. Authorization for Employment/Educational Information.

I authorize the references listed in this Application for Employment, and any prior employer, educational institution, or any other persons or organizations to give this Company any and all information concerning my previous employment/educational accomplishments, disciplinary information or any other pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I hereby waive written notice that employment information is being provided by any person or organization.

3. Employment at Will.

If I am hired, in consideration of my employment, I agree to abide by the rules and policies of this Company, including any changes made from time to time, and agree that my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either the Company or myself. I understand that no manager or other representative of the Company, other than the President, has any authority to enter into any agreement for employment for any specific or indefinite period of time, or to make any agreement contrary to the foregoing. Any such agreement made by the President must be made in writing to be effective.

4. Authorization to Work.

If I am selected for hire, I will be offered employment provided I verify that I am authorized to work as required by the Immigration Reform and Control Act of 1986.

5. Limitation on Claims.

I agree that any lawsuit or claim against the Company arising out of my employment or termination of employment (including, but not limited to, claims arising under state, federal or local civil rights laws) must be brought within the following time limits or be forever barred: (a) for lawsuits requiring a Notice of Right to Sue from EEOC, within 90 days after the EECO issues that Notice; or (b) for all other lawsuits, within (i) 180 days of the event(s) giving rise to the claim, or (ii) the time limit specified by statute, whichever is shorter. I waive any statute of limitations that exceeds this time limit.

6. Need for Accommodation.

If I have a mental or physical disability and require an accommodation to perform the job, I must notify the Company of that need in writing within 182 days after I knew or reasonably should have known that an accommodation was needed. Failure to do so will bar me from alleging that the Company has not accommodated me as required by law.

7. Criminal Records Check.

I authorize the Company to secure my criminal conviction history. I agree to execute the appropriate authorization if necessary to obtain such information.

8. Driving Record Check.

I agree to execute an authorization for this employer to inquire into, and obtain documents related to, any driving record from every state in which I have held a motor vehicle operator’s license or permit.

9. Release of Medical Information.

I authorize every medical doctor, physician or other health care provider to provide any and all information, including but not limited to, all medical reports, laboratory reports, X-rays or clinical abstracts relating to my previous health history or employment in connection with any examination, consultation, test or evaluation. I hereby release every medical doctor, health care personnel and every other person, firm, officer, corporation, association, organization or institution which shall comply with the authorization or request made in this respect from any and all liability. I understand that this release will not be sent to my physician or other health care provider until a conditional job offer has been made.

10. Physical Exam and Drug and Alcohol Testing.

I agree to take a physical exam following a conditional job offer. I also authorize the Company or its designated agent(s) to withdraw specimen(s) of my blood, urine, hair and/or other substances for chemical analysis. One purpose of this analysis is to determine or exclude the presence of alcohol, drugs or other substances. I understand that decisions concerning my employment may be made as a result of these tests.

11. Consideration for Employment.

I understand that my application will be considered pursuant to the Company's normal procedures for a period of thirty (30) days. If I am still interested in employment thereafter, I must reapply.

I agree that if any of the above commitments is ever found to be legally unenforceable as written, the particular commitment concerned shall be limited to allow its enforcement as far as legally possible.

I have read, understand, and agree to items 1 through 11 above. I knowingly and voluntarily acknowledge that with my signature below.

Date / Time *

Date

Time

Applicant's Signature: *

For your information: We base our hiring decisions on a variety of factors, including skills and ability to perform the job, prior employment with us, employment references as to character and willingness to work, willingness to accept the offered salary, and personal interviews. Further, our need to hire may change without notice as business conditions change. We do not discriminate on the basis of race, sex, color, age, union affiliation, national origin, disability, or any other status protected by law.

In addition to this application, please email your resume to:

ybedolla@pioneerinc.com

BUILD YOUR FUTURE AT PIONEER

Previous Employment

Education

Business References

APPLICANT'S CERTIFICATION AND AGREEMENT

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