Mader Southeast Job Application

Full Legal Name

First NameMiddle Name/InitialLast Name

Present Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Permanent Address (If Different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Social Security Number

Are you 18 years or older?

Personal Phone

Please enter a valid phone number.Format: (000) 000-0000.

Business Phone

Please enter a valid phone number.Format: (000) 000-0000.

Position Applying For

Dates You Are Available

Salary Desired

Are you employed now?

Are you authorized to work in the U.S.?

May we contact your current employer?

Do you have reliable transportation to and from work?

What type of hours are you able to work?

Part Time From

To

Will you work overtime if the job requires it?

If no, please explain

Would you travel if the job requires it?

How were you referred to Mader

If you are a former Mader employee when were you employed?

Do you have previous experience in the position you desire?

Years of experience in desired position

Are you able to perform the essential functions of the job for which you are applying with or without reasonable accommodations?

If no, describe functions that cannot be performed:

Have you ever been a defendant in a civil action for an intentional tort (I.E.: a civil charge for assault, battery, intentional infliction of emotional distress, false imprisonment, wrongful death, etc.)

If yes, explain

Have you entered into an agreement with any former employer or other party (such as a non-competition agreement) that might in any way restrict your ability to work for mader southeast?

If yes, explain

High School Location

High School # of Years Completed

High School Did You Graduate?

High School Degree/Diploma

College/University Location

College/University # of Years Completed

College/University Did You Graduate?

College/University Degree/Diploma

Other Location

Other # of Years Completed

Other Did You Graduate?

Other Degree/Diploma

Name of present or last employer

Name of Supervisor

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Job Title

Start Date

Date

Leave Date

Date

May we contact your supervisor?

Starting Wage

Final Wage

Description of Job Duties

What did you like most about your job?

What did you like least about your job?

Reason for Leaving

Name of previous employer

Name of Supervisor

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Job Title

Start Date

Date

Leave Date

Date

May we contact your supervisor?

Starting Wage

Final Wage

Description of Job Duties

What did you like most about your job?

What did you like least about your job?

Reason for Leaving

Name of previous employer

Name of Supervisor

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Start Date

Date

Leave Date

Date

May we contact your supervisor?

Starting Wage

Final Wage

Description of Job Duties

What did you like most about your job?

What did you like least about your job?

Reason for Leaving

Please explain any gaps in employment other than those due to personal illness, injury or disability.

Have you ever been fired or asked to resign from a job?

If yes, explain

Certifications related to safety ( for example: OSHA 10 hour, OSHA 30 hour, basic first aid, aed/CPR). Only include safety skills for which you have documentaion ( for example: wallet cards )

Safety Certifications

Military Service - Special skills or abilities as the result of service in the military

Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? (Note: Convictions for marijuana related offenses that are more than two years old need not be listed).

Convictions will not necessarily disqualify an applicant for employment. Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.

Languages Spoken (Fluent)

Special Licenses or Certifications

Other experience, training, qualifications, or skills that you feel are relevant to employment with this company

Name

Title

Company

Telephone

Please enter a valid phone number.Format: (000) 000-0000.

Years Associated

Reference 2 Name

Reference 2 Title

Reference 2 Company

Reference 2 Telephone

Please enter a valid phone number.Format: (000) 000-0000.

Reference 2 Years Associated

Reference 3 Name

Reference 3 Title

Reference 3 Company

Reference 3 Telephone

Please enter a valid phone number.Format: (000) 000-0000.

Reference 3 Years Associated

TRUTHFULNESS OF APPLICATION

I certify that the facts set forth in this employment application are true and complete to the best of my knowledge. I understand that the misrepresentation or omission of material facts may result in the termination of my employment.

TRUTHFULNESS OF APPLICATION INITIAL:

AUTHORIZATION TO INVESTIGATE

I authorize any of the persons or organizations referenced in this application to give Mader Southeast any and all information related to my previous employment, education or any other information they might have, with regard to any of the subjects covered by this application, and release all such parties from the liability for any damage that may result from furnishing such information. I authorize the company to request and receive such information.

AUTHORIZATION TO INVESTIGATE INITIAL:

AT WILL RELATIONSHIP

I understand and agree that if I am offered employment with Mader Southeast it will be an "at-will" basis. This means that either I or Mader Southeast may terminate the employment relationship at any time and for any reason, with or without cause. Further I understand the "at-will" nature of my employment with the company is an aspect of employment that cannot be modified or changed, except by a written agreement signed by the chief executive officer of Mader Southeast. I understand that nothing contained in the application, or conveyed during the interview which may be granted during my employment, if hired, is intended to create an employment contract between me and Mader Southeast.

AT WILL RELATIONSHIP INITIAL:

SEARCH OF PUBLIC RECORDS:

Should a search of public records - including records of arrest, indictment, conviction, civil judicial action, tax lien, or outstanding judgement -- be conducted by internal personnel employed by Mader Southeast, I am entitled to copies of any such public records obtained by Mader Southeast unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below.

SEARCH OF PUBLIC RECORDS INITIAL:

I waive receipt of a copy of any public record described in the above paragraph.

DRUG FREE WORKPLACE

I understand that Mader Southeast is firmly committed to maintaining a drug-free work place and consistent with our objective, we require all applicants accepted for employment to pass a drug test as part of our application process. All offers of employment are contingent upon satisfactory results of a drug-screening test. If you are hired by Mader Southeast you may be required, from time to time, to submit to drug and alcohol screening tests to determine compliance with the company's policy to provide a drug-free workplace.

DRUG FREE WORKPLACE INITIAL:

Signature

Date

Job Application

Preliminary Application

Personal Information

Application for Employment

Personal Information

Desired Employment

AVAILABILITY:

Performance of Essential Job Functions

Education

Employment History

Safety Certifications

Convictions

Languages Spoken

Additional Information

Professional References

Authorizations & Acknowledgments

DO NOT SIGN UNTIL YOU HAVE READ EACH STATEMENT