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Employment Application

CONTACT INFORMATION

Your Name (required)
Your Email (required)
Cell Phone(required)
Other Phone
Permanent Address (required)

GENERAL INFORMATION

Have you ever been convicted of a felony?
 Yes No
If so, please provide details:
Position Applying For:
Are you legally allowed to work in the US?
 Yes No
Are you a US citizen?
 Yes No
If not, do you have a VISA or Greencard?
 Yes No
How many hours can you work weekly?
Hourly rate desired:
Are you available on weekends?
 Yes No
How did you hear about us?

DRIVING INFORMATION

Do you have a valid drivers license?
 Yes No
If not, what are your means of transportation?
Drivers License Number:
State:
Expiration:
What type of license is it?
Do you have a car?
 Yes No
If so, what kind?

Make:

Model:
Year:
Have you had any moving violations during the past 3 years?
 Yes No
If so, how many?
Have you had any accidents during the past 3 years?
 Yes No
If so, how many?

EDUCATION

School #1
Type of School:
Name of School:
Dates Attended:
# of Years Comnpleted:
Major/Degree Completed:
School #2
Type of School:
Name of School:
Dates Attended:
# of Years Comnpleted:
Major/Degree Completed:
School #3
Type of School:
Name of School:
Dates Attended:
# of Years Comnpleted:
Major/Degree Completed:

MEDICAL ISSUES

In the past three years, have you experienced any medical conditions which may impair or limit your ability to perform the position for which you are applying, including but not limited to back problems, hernia, heart conditions, or epilepsy?
 Yes No
If YES, please explain:

WORK EXPERIENCE

Please list your employment history, starting from the most recent job held.

Most Recent Job

Employer Info (Name, Phone Number, Address):
Job Title:
Duties:
Employment Dates:
Salary:
Immediate Supervisor:
Reason for Leaving:
May We Contact this Employer for Reference?
 Yes No
Previous Employment
Employer Info (Name, Phone Number, Address):
Job Title:
Duties:
Employment Dates:
Salary:
Immediate Supervisor:
Reason for Leaving:
May We Contact this Employer for Reference?
 Yes No
Previous Employment
Employer Info (Name, Phone Number, Address):
Job Title:
Duties:
Employment Dates:
Salary:
Immediate Supervisor:
Reason for Leaving:
May We Contact this Employer for Reference?
 Yes No

PERSONAL REFERENCES

First Personal Reference
Name:
Address:
Company:
Relationship to You:
Phone Number:
SecondPersonal Reference
Name:
Address:
Company:
Relationship to You:
Phone Number:
Third Personal Reference
Name:
Address:
Company:
Relationship to You:
Phone Number:

SKILLS / PERSONAL STATEMENT

Why did you decide to apply to Blue Door Painters, Inc.?
What skills/experience do you bring us?
What is your definition of excellent customer service?
What machines or equipment have you operated that relate to the position you are applying for?
What other skills do you have that might assist you in the position you are applying for?
Do you have your own painting tools?

What kind of work have you done? (Check all that apply.)

APPLICANT RELEASE

False information given or implied on an application form is grounds for immediate dismissal without further notice. I hereby state that all information provided is accurate and may be verified by you.

I agree that I may be discharged if the information provided on this application form and related documents is found to be false or have material omissions. If agreed above, Blue Door Painters, Inc. may contact my former employer(s) in connection with my employment with them. All references are herby authorized to release all information which they may have relevant to my employment with them. I hereby release Blue Door Painters, Inc. from any liability that might be claimed because of information provided by such references.

Date:
Name:
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