Bachetti Bros Pre-Employment Application Form

Employment Application

Our client is an equal opportunity employer. Applicants will be considered regardless of race, color, national origin, religion, gender, age, marital, or veteran status; medical condition, disability; or any other legally protected status. Equal access to the hiring process, services, and employment is available to all individuals. Applicants requiring accommodations to the application and/or interview process should contact the Human Resource Representative.

Each question should be answered completely and accurately.

No action will be taken on this application until all questions have been answered and the application has been signed and dated. Verification of eligibility to work in the U.S. will be required if an employment offer is made.

Full Name*

First NameLast Name

Phone Number*

E-mail*

Confirmation Email

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Position(s) applying for*

Wage expectations*

Referral source

Are you over the age of 18?*

YESNO

Are you eligible to work in the United States?*

YESNO

Are you currently employed?*

YESNO

Date available for work*

MonthDayYear

Are you available to work?*

Full timePart timeShift workTemporary

Have you applied here before?*

YESNO

If yes, give date:*

Have you been convicted of a felony?*

YESNO

EDUCATION

Highest level of education completed:*

Please complete the appropriate sections

	School Name & Location	Years Attended	Did You Graduate?	Degree or Certification
GED / High School
Trade School
College
Graduate

WORK HISTORY

Please list your four most recent employers, list the most recent first

1. Employer

Employer's Name (Most current)*

Address & location of business*

Your title*

May we contact this employer?*

YESNO

Supervisor's name*

First and Last Name

Phone Number*

Start date*

MonthDayYear

End date

MonthDayYear

Wages:*

Work performed:*

Reason for leaving*

2. Employer

Employer's Name (Second most recent)*

Address & location of business*

Your title*

May we contact this employer?*

YESNO

Supervisor's name*

First and Last Name

Phone Number*

Start date*

MonthDayYear

End date

MonthDayYear

Wages:*

Work performed:*

Reason for leaving*

3. Employer

Employer's Name (Third most recent)

Address & location of business

Your title

May we contact this employer?

YESNO

Supervisor's name

First and Last Name

Phone Number*

Start date

MonthDayYear

End date

MonthDayYear

Wages:

Work performed:

Reason for leaving

4. Employer

Employer's Name (Fourth most recent)

Address & location of business

Your title

May we contact this employer?

YESNO

Supervisor's name

First and Last Name

Phone Number*

Start date

MonthDayYear

End date

MonthDayYear

Wages:

Work performed:

Reason for leaving

ADDITIONAL INFORMATION

Do you have a U.S. military service record?*

YESNO

Click to edit

If yes, branch of service*

Discharge date and rank*

List job-related accomplishments, projects, and awards. (Exclude information that would reveal race, color, national origin, religion, gender, age, marital, or veteran status; medical condition, disability; or any other legally protected status.)

List any additional information you would like us to consider:

REFERENCES

List three professional references, (business or work, not relatives) that you have known for at least one year. List at least one previous supervisor.

1. Full Name*

First NameLast Name

Company*

Best phone number to reach them*

Area CodePhone Number

Years acquainted*

Relationship*

2. Full Name*

First NameLast Name

Company*

Best phone number to reach them*

Area CodePhone Number

Years acquainted*

Relationship*

3. Full Name*

First NameLast Name

Company*

Best phone number to reach them*

Area CodePhone Number

Years acquainted*

Relationship*

AUTHORIZATION

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the forgoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

I understand that a consumer credit report, DMV, previous employment, education and personal references, and/or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

By entering your name, you agree to accept the terms of the above document with an electronic signature.*

I agreeI do not agree

You must agree to accept the terms of the document in order to submit an application.

Type signature*

Date*

MonthDayYear

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Please verify that you are human*