Employment Application

Employment Application

1168 Greenfield Drive El Cajon, CA 92021 Ph: (619)447-5438 Fax: (619)444-2505
Name*

First NameMiddle NameLast Name
Date

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*
Email*
example@example.com
Date Available*

MonthDayYear
Social Security No*
Upload Social Security Card*

Cancelof
Upload Another Form of Identification*

Cancelof
Desired Salary*
Position Applying for*
Are you a citizen of the United States?*

YesNo
If no, are you authorized to work in the U.S.?*

YesNo
Have you ever worked for this company?*

YesNo
If yes when*
Have you ever been convicted of a felony?*

YesNo
If yes explain*
Education
Education Selection*

High SchoolCollegeOther
High School*
Address*
From*

MonthDayYear
To*

MonthDayYear
Did you graduate?*

YesNo
Diploma*
College*
Address*
From*

MonthDayYear
To*

MonthDayYear
Did you graduate?*

YesNo
Degree*
Other*
Address*
From*

MonthDayYear
To*

MonthDayYear
Did you graduate?*

YesNo
Degree
Please list technical trade skills relevant to this position
Previous Employment
Company*
Phone*
Address
Supervisor*
Job Title*
Starting Salary*
Ending Salary*
Responsibilities*
From*

MonthDayYear
Date
To*

MonthDayYear
Date
Reason for Leaving*
Previous Employment 2
Company
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From

MonthDayYear
Date
To

MonthDayYear
Date
Reason for Leaving
Previous Employment 3
Company
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From

MonthDayYear
Date
To

MonthDayYear
Date
Reason for Leaving
Emergency Contact
Name*
Phone*
Relationship*
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, / understand that false or misleading information in my application or interview may result in my release.
Signature*

Clear
Date*

MonthDayYear
VOLUNTARY SELF-IDENTIFICATION
Modern Masonry is a government contractor subject to the provisions of Executive Order 11246, Section 4212-Vietnam Era Veterans' Readjustment Act of 1974, and Section 503 of the Rehabilitation Act of 1973. These Acts require the Company to take affirmative action to employ qualified individuals.

Completion of this form is voluntary. The information is for statistical purposes only, and will be kept confidential and separate from your application. If you prefer not to provide this information, please state SO by checking the box below. Refusal to provide the information will not deny you further employment consideration.
NAME
DATE

MonthDayYear
Date
POSITION APPLYING FOR
Please make aselection in each of the following sections:
RACE/ETHNICITY

Caucasian/White - Person of Indo-European descentAfrican American/Black - Person with origins in any of the Black African racial groups, not of Hispanic origin.Asian/Pacific Islander - Person having origins from the Far East, Southeast Asia, the Indian subcontinent or the Pacific Islands.American Indian/America Alaskan Native - Person descended from original North who maintains cultural identification through tribal affiliation.Hispanic/Latin American - Person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish descent.I prefer not to provide this information
SEX/GENDER

MaleFemaleI prefer not to provide this information
Attestation of Vaccination Status - California
Modern Masonry will follow the California OSHA requirements for employers where fully vaccinated people can resume activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.

The process Modern Masonry has chosen to ensure the safety of our employees is to get a signed attestation of full vaccination from those that choose to no longer wear face coverings in the workplace.

Face coverings will still need to be worn if required by the jobsite rules, local jurisdictions, or other more stringent guidelines Modern Masonry is required to follow.

For purposes of this certification, you are considered "fully vaccinated" two weeks after completing the second dose of a two-dose COVID-19 vaccine (e.g., Pfizer or Moderna) or two weeks after receiving a single dose of a one-dose vaccine (e.g., Johnson & Johnson/Janssen)

I also understand that if I state that I am fully vaccinated, my employer may request documentation of my vaccination status (e.g., a copy of my vaccine card or other similar, official document confirming vaccination status) to comply with local and/or project-specific requirements.

In addition, I acknowledge that I have read Modern Masonry's guidelines for vaccinated and unvaccinated employees.
By signing and returning this form, I truthfully attest that I have been*

"fully vaccinated" as outlined above.I have not been vaccinated. I understand I am required to wear a face covering at all times.
Employee Name*
Employee Signature*

Clear
Todays Date*

MonthDayYear
Employee Name*
Employee Signature*

Clear
Todays Date*

MonthDayYear
Date
Ph: 619.447.5438 | Fax: 619.444.2505
1168 Greenfield Drive | El Cajon, CA 92021 | Lci #605172
Should be Empty:

Employment Application

Education

Previous Employment

Emergency Contact

Disclaimer and Signature

VOLUNTARY SELF-IDENTIFICATION

Attestation of Vaccination Status - California