EMPLOYMENT INQUIRY FORM

Don Luchetti Construction

Don Luchetti Construction 565 Distribution Dr, Melbourne, FL 32904. We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this form is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the form, application and/or interview process should notify a representative of the organization. If offered a position and prior to hiring, all applicants will be verified in e-Verify System and will be sent for drug testing.
Full Name*

First NameMiddle NameLast NameSuffix
Address*

Address 1

Address 2

CityState

Zip Code
Position Applied For / Desired*
Date you will be available to start work*

MonthDayYear
Date
Type Of Employment*

Full TimePart TimeTemporary
Birth Date*

MonthDayYear
Mobile Number*

Area CodePhone Number
Home Number

Area CodePhone Number
How Did You Hear About Us?*
Can you submit proof of legal employment authorization and identity?*

YesNo
Do you have any objection for us to do a Pre-Employment Background Check?*

YesNo
Do you have any objection to taking a Drug Screening Test? If, you are considered for the position?*

YesNo
Have you ever been convicted of a felony crime in the last 7 years?*

YesNo
If yes, please explain (a conviction will not automatically bar employment)
Employment History

Please provide all employment information for your past two employer's starting with the most recent

Work 1
Company Name Address And Phone Number*
Position*
Immediate Supervisor and their title*
Job Summary*
Salary*
Reason For Leaving*
From*

TagMonatJahr
Date
To*

TagMonatJahr
Date

Work 2
Company Name Address And Phone Number*
Position*
Immediate Supervisor and their title*
Job Summary*
Salary*
Reason For Leaving*
From*

TagMonatJahr
Date
To*

TagMonatJahr
Date
Character Reference (3):

Tell us about the person whose well known to you (do not include relatives or employers)
Name*

First NameLast Name
Contact No*

Area CodePhone Number
Years Known*
Name*

First NameLast Name
Contact No*

Area CodePhone Number
Years Known*
Name*

First NameLast Name
Contact No*

Area CodePhone Number
Years Known*
Summarize any job-related training, skills, licenses, certificates, and/or other qualifications:
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Disclaimer & Signature

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person’s need for a reasonable accommodation as required by the ADA.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.
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