Employment Application

Lundberg Builders, INC.

314 Main Street, Stevensville, MD 21666
An Equal Opportunity Employer
Personal Information:
Full Name*

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Are you legally eligible to work in this country?

YesNo
Are you over the age of 18?

YesNo
Have you ever been convicted of a felony, misdemeanor, or any offense other than a minor traffic violation? Convictions will not necessarily disquilify you from employment?

YesNo
Explain:
Employment Desired:
Position Applied For:
Full timePart TimeTemporary
Date You Can Start

MonthDayYear
Salary Desired
Have You Worked Here Before?

YesNo
Have You Applied Here Before?

YesNo
How or by whom were you referred to us?
Education:
High School
Name of High School Attended
Number of Years Attended
Graduated?

Yes
College
Name of College/University Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Graduate School
Name of Graduate School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
If you did not graduate, why and when did you leave school or college?
Are you planning to pursue further studies?

YesNoDay SchoolNight SchoolFull TimePart Time
If yes, when, where, and what course(s):
Skills/Qualifications:
Skills
Use this space to describe skills and aptitudes that you feel qualify you for a position at this company. You may wish to include civic and community activities, professional societies in which you participate, hobbies, sports, special training or skills such as typing, accounting, bookkeeping, computer/CRT machine, word processing, adding machine, or other skills. Please do not list organizations or activities which reveal race, religion, age, sex, national origin, or ancestry, sexual orientation, disability or political persuasion. List only organizations that you consider relevant to your ability to do the job which you are applying.
Qualifications
List any relevant certifications or qualifications. (Example: If applying for carpentry you may want to list any job specific training, vocational certifications or seminars you attended. For administrative or office, note training such as word processing, computer software classes or job specific training.)
List scholastic honors, offices held, and activities in high school or college.
Do not list organizations which reveal race, creed, color, national origin, religion, age or sex.
Current Employment:
Current Employer
Name of Current Employer or NONE if not Employed
Position
Salary
Reason for Leaving?
Start Date

MonthDayYear
May We Contact?

YesNo
Previous Employment:
Previous Employer
Name of Previous Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Name of Supervisor

First NameLast Name
May we contact this employer?

YesNo
Position
Salary
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
Previous Employer
Name of Previous Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Name of Supervisor

First NameLast Name
May we contact this employer?

YesNo
Position
Salary
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
If presently employed, why do you wish to change positions?
References:
Reference 1
Name of Reference
Relationship
Years Acquainted
Phone
Email
Reference 2
Name of Reference
Relationship
Years Acquainted
Phone
Email
Reference 3
Name of Reference
Relationship
Years Acquainted
Phone
Email
Cover Letter & Resume (Optional):
Cover Letter

Upload a File

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Resume

Upload a File

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Please Read Before Signing
If you have any questions regarding the following statements, please ask them of an employment interviewer before signing this applications.

Lundberg Builder, Inc. is an equal opportunity employer and does not descriminate in its hiring or employment practices on the basis of race, color, religion, age, sex, sexual orientation, national origin or ancestry, disability, martial status, veteran status, or status within any other group protected by applicable federal, state and local nondiscrimination laws. No questions on this application are inteded to secure information to be used for such discrimination.

By signing your name below, you acknowledge and certify:
- that all statements made by me on this application are true and complete to the best of my knowledge.
- that I have withheld nothing that would affect this application unfavorably.
- that any offer I may receive from the Company is contingent upon mt successdul completion of the Company's total preemployment screening process.
- that I understand that misrepresentations or omissions may be cause for rejection, or may be cause for subsequent dismissal if I am hired.
I also understand that nothing contained in this application or in the interview process is intended to create an employment contract between the Company and myself. Should this application result in my employment, it will be an at-will relationship. I have the right to terminate my employment at any time and for any reason and the Compamy retains the same right. I agree to conform to the rules and regulations of the Company. I furthur understand that no person of the Company other than the Attorney/Owner has any authority to enter into any agreement with me for any specified period of time or to quarantee some other benefit above the normal employee benefit package.

I further understand this entire statement applies to the period prior to, or after, I may be employed.

I understand that past employers/educational insitutions and/or military will be contacted for references and I authorize any such organization to provide the requested information. I further release and forever discharge the Company, its agents, its employees, and the individuals and companies contacted by this Company as part of it inquiries and investigations, from any and all claims, demands, damages, actions, causes of actions, or suits of any kind or nature whatsoever arising from the Company's inquiries and investigation of my credentials and information in connection with my application.

I hearby acnowledge that I have read and understand each of the above statements. I authorize release of the information about me to this Company.
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Lundberg Builders, INC.

An Equal Opportunity Employer

Personal Information:

Employment Desired:

Education:

Skills/Qualifications:

Current Employment:

Previous Employment:

References:

Cover Letter & Resume (Optional):

Please Read Before Signing