Name Today's Date Attached you will find an application for employment. Prior to filling it out please
read the following and sign at the bottom of this sheet.
Warth Construction, Inc. appreciates your interest in employment with us. We
pride ourselves on our quality of work and conviviality. Please read the following
requirements of employment and feel free to discuss any of these with the hiring
manager.
1. Warth Construction, Inc. uniform requirement consists of jeans, shoes
or boots (no sandals or canvas) and socks. Shirts are to be worn at all
times. No tank tops.
2. Warth Construction, Inc. requires you to come to work in a clean, nontorn, uniform demonstrating good personal hygiene habits. If hair is
long it must be worn pulled back off of your shoulders and out of your
face.
3. Transportation to and from work for your scheduled shift is required.
We do not pick up or drop off employees.
4. As a condition of employment, Warth Construction, Inc. requires a
criminal background check. By signing below you authorize us to
procure that report.
5. You must be able to provide two forms of identification one with a
picture and one with your social security number on it.
6. Warth Construction, Inc. is a drug-free environment.
7. Warth Construction, Inc. employees are expected to arrive to work on
time for scheduled shifts and are expected to work the entire shift.
8. Warth Construction, Inc. promotes teamwork and we expect our
employees to promote the same team attitude.
9. Part of Warth Construction, Inc. cleanliness program requires all
employees to participate in any jobsite related clean up tasks.
10. Profanity will not be tolerated within Warth Construction, Inc. and is
cause for termination.
11. Phone use is not permitted unless it is an emergency. Personal phone
calls may not be made or received on the jobsite.
This form is designed to give prospective applicants an idea of what Warth
Construction, Inc. requires from our employees. Please sign on the applicable
line below and return to the hiring manager once you are finished. Thank you for
your interest in Warth Construction, Inc.
I would like to apply for employment at this time. (Fill out application and to Warth
Construction, Inc. office)
Signature
Date
EMPLOYMENT APPLICATION
POSITION
RATE
DATE
I
IS
I
I
MANAGER USE ONLY
NOTE: Please print firmly with ball point pen. Use your legal name. Do not use nicknames.
MIDDLE INITAL
FIRST NAME
LAST NAME
STREET ADDRESS
CITY
VERIFICATION OF EMPLOYMENT
EDUCATION
YES
NO
No
Yes
HIGHEST GRADE COMPLETED? (circle one) 6 7 8 9 10 11 12 13 14 15 16
SCHOOL ADDRESS
YES
HAVE YOU BEEN CONVICTED OF ANY CRIME?
WHEN
OFFENSE
NO
IF YES, ANSWER QUESTIONS BELOW:
DISPOSITION OF CASE
STATE
CITY
STREET ADDRESS
EMERGENCY CONTACT NAME EMPLOYMENT RECORD
IF UNDER AGE 18 WHAT IS YOUR AGE? Can you, after being hired, furnish verification of your legal right to work in the US?
LAST SCHOOL ATTENDED
DATE AVAILABLE FOR WORK
IF HIRED, CAN YOU SHOW PROOF OF AGE?
****Under 18 years of age requires work permit. ZIP CODE
STATE
WAGES DESIRED
POSITION DESIRED - 1st CHOICE
ZIP CODE
STATE
CITY
PREVIOUS STREET ADDRESS
TELEPHONE NUMBER
PHONE NUMBER
List present or most recent position first. May we contact your present employer? YES NO
DATES EMPLOYED: FROM: (MO/YR) TO (MO/YR)
TELEPHONE NUMBER
COMPANY NAME
CITY
STREET ADDRESS
SUPERVISOR
STATE
BASE PAY
SPECIFIC REASON FOR LEAVING
TYPE OF WORK PERFORMED
DATES EMPLOYED: FROM: (MO/YR) TO: (MO/YR)
TELEPHONE NUMBER
COMPANY NAME
CITY
STREET ADDRESS
SUPERVISOR
STATE
BASE PAY
SPECIFIC REASON FOR LEAVING
TYPE OF WORK PERFORMED
DATES EMPLOYED: FROM: (MO/YR) TO: (MO/YR)
TELEPHONE NUMBER
COMPANY NAME
CITY
STREET ADDRESS
SUPERVISOR
STATE
BASE PAY
SPECIFIC REASON FOR LEAVING
TYPE OF WORK PERFORMED
**IS THERE ANY MENTAL/PHYSICAL CONDITION WHICH WOULD LIMIT YOUR ABILITY TO PERFORM WORK IN THE POSITION FOR WHICH YOU ARE APPLYING? YES NO IF YES, PLEASE EXPLAIN:
(Not former employers or relatives)
PERSONAL REFERENCES
Name and Occupation
Address
Phone Number
*BY SIGNING, I UNDERSTAND THAT INCORRECT, MISLEADING OR INCOMPLETE INFORMATION ON THIS APPLICATION WILL BE CONSIDERED
VIOLATION OF COMPANY POLICY AND WILL RESULT IN IMMEDIATE TERMINATION OF EMPLOYMENT.
Applicant's Signature
Date
I
AUTHORIZATION AND RELEASE FOR THE PROCUREMENT
OF A CONSUMER AND/OR INVESTIGATIVE REPORT
I, the undersigned consumer, do hereby authorize Warth Construction, Inc. by and through its
independent contractor, ABIKA, INC., to produce a consumer report and/or investigative consumer report
on me.
These above mentioned reports may include, but are not limited to, employment ad education verification;
personal references; citations; a social security number verification; present and former addresses;
criminal and civil history/record; and any other public record; and any other information bearing on my
credit standing, credit capacity, worthiness, character, general reputation, personal characteristics,
trustworthiness and/or mode of living.
I understand that the investigative consumer report I have authorized above may include information
obtained by interviews with my neighbors, friends and/or associates and/or others with whom I am
acquainted or who may have knowledge concerning said information. I understand that I am entitled to a
complete and accurate disclosure of the nature and scope of any investigative consumer report prepared
on me upon written request to Warth Construction, Inc. that is made within a reasonable time after the
date hereof.
I further authorize any person, business entity or governmental agency who may have information
relevant to the above to disclose the same to Warth Construction, Inc., by and through ABIKA, INC.,
including but not limited to, any courthouse, any public agency, any and all law enforcement agencies and
any and all credit bureaus, regardless of whether such person, business entity or governmental agency
compiled the information itself or received it from other sources, including alcohol and controlled
substance information from previous employers.
I hereby release Warth Construction, Inc. and ABIKA, INC. and any and all persons, business entities and
governmental agencies, whether public or private, from any and all liability, claims and/or demands, of
whatever kind, to me, my heirs, or others making such claim or demand on my behalf, for procuring,
selling, providing, brokering, and/or assisting with the compilation or preparation of the consumer report
and/or investigative consumer report hereby authorized.
PRINTED NAME:
First
SIGNATURE:
Middle
Maiden/Other (within past 7 years only)
Last
DATE:
COMPLETE RESIDENCE ADDRESS:
Street Name
Street Number/P 0 Box
DAYTIME TELEPHONE NUMBER: SOCIAL SECURITY NUMBER: *DATE OF BIRTH: STATE ISSUED: DRIVER'S LICENSE #: County
Zip Code
State
City
*GENDER: * This information is voluntary. However, without this information, we will be unable to properly identify you in
the event we find adverse information during the course of our background search.
PLEASE LIST ALL ADDITIONAL RESIDENCES THAT YOU HAVE RESIDED IN THE PAST FIVE (5) YEARS:
Street Number/P 0 Box
Street Name
City
State
Zip Code
County
Street Number/P 0 Box
Street Name
City
State
Zip Code
County
Street Number/P 0 Box
Street Name
City
State
Zip Code
County