GCI Application for Employment

Full Name*

First NameMiddle NameLast Name

Birth Date*

MonthDayYear

Current Address*

Street Address

Street Address Line 2

CityState

Zip Code

Email Address*

example@example.com

Phone Number*

1a) Position for which you are applying?*

1b) Location for which you are applying?*

Northern Division (Sarver, PA)Southern Division (Mims, FL)

2) How did you hear about us?

3) Are you presently employed?*

YesNo

If yes, please enter employer's name and address

How long have you been with this employer?

Present salary and/or salary requirements:

4) Available Start Date

Date

5) Are you Authorized to work in the United States?*

YesNo

6) Have you ever been dismissed, or asked to resign from any position?*

YesNo

7) Have you ever been convicted of a felony, or a misdemeanor which resulted in imprisonment? (A yes answer to the above does not necessarily disqualify an applicant from employment)*

YesNo

If you answered Yes to number 6 or 7, please explain.

8) Education - please list all schools attended / majors / dates and any other important information about your education.

9) Employment Experience - please list your 3 to 5 most recent employment experiences

10) References - please list name, address, phone and relationship of 3 or more references

Upload Your Resume

Cover Letter

Invitation to Self-Identify as an Individual with a Disability (optional).

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualifiedpeople with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says wemust measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disabilityor have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one whomakes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If youwant to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract CompliancePrograms (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

• Alcohol or other substance use disorder (not currently using drugs illegally)
• Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
• Blind or low vision
• Cancer (past or present)
• Cardiovascular or heart disease
• Celiac disease
• Cerebral palsy
• Deaf or serious difficulty hearing
• Diabetes
• Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
• Epilepsy or other seizure disorder
• Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
• Intellectual or developmental disability
• Mental health conditions, for example, depression, bipolar disorder, anxiety
disorder, schizophrenia, PTSD
• Missing limbs or partially missing limbs
• Mobility impairment, benefiting from the use of a wheelchair, scooter, walker,
leg brace(s) and/or other supports
• Nervous system condition, for example, migraine headaches, Parkinson’s
disease, multiple sclerosis (MS)
• Neurodivergence, for example, attention-deficit/hyperactivity disorder
(ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning
disabilities
• Partial or complete paralysis (any cause)
• Pulmonary or respiratory conditions, for example, tuberculosis, asthma,
emphysema
• Short stature (dwarfism)
• Traumatic brain injury

Please check one of the boxes below (optional):

Yes, I have a disability, or have had one in the pastNo, I do not have a disability and have not had one in the pastI do not want to answerType option 4

By submitting this application, you, the Applicant, acknowledge that Gregori Construction Inc. is an at will employer, and an employee can be terminated at any time for any reason or no reason.*

I acknowledge and understand this statement above