Lieber Construction/Bridgeport Materials Application

Lieber Construction/Bridgeport Materials Application
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
SSN
DOB
Drivers License Number
Position Applied For
Full or Part Time
Have you worked for Lieber Construction or Bridgeport Materials in the past?

YesNo
If Yes, When

MonthDayYear
Date
Reason for Leaving
When are you available to begin work?

MonthDayYear
Date
Are you a Citizen of the US or otherwise leagally authorized to work in this country?

YesNo
Have you ever been convicted of a felony?

YesNo
If Yes, When?

MonthDayYear
Date
- A Conviction record will not necessarily make you ineligible for employment
- Factors such as time, situation factors, seriousness and nature of the violation will be taken into account
Have you ever been convicted of driving under the influence of drugs/alcohol within the last 5 years?

YesNo
If Yes, When?

MonthDayYear
Date
Have you ever had your driver's license suspended or revoked?

YesNo
Do you drink alcohol?

YesNo
Do you currently use illegal drugs?

YesNo
Highest grade level completed
Why should Lieber Construction/Bridgeport Materials hire you?
Employment Record:

Latest employment first. Please include military service, self-employment and periods of Unemploymen
Employer Name
Supervisor
Address
Phone Number
Dates of Employment
Rate of Pay
Are you presently employed?

YesNo
May we contact this employer?

YesNo
Reason for leaving
Employer Name
Supervisor
Address
Phone Number
Dates of Employment
Rate of Pay
Are you presently employed?

YesNo
May we contact this employer?

YesNo
Reason for Leaving
Employer Name
Supervisor
Address
Phone Number
Dates of Employment
Rate of Pay
Are you presently employed?

YesNo
May we contact this employer?

YesNo
Reason for leaving
I hearby acknowledge that prior to submitting this application, I have been informed that the information provided herein may be used to conduct current and previous employers, references or any other individuals this company considers necesary.

I hearby authorize my current and previous employers, references and other individuals contacted by this company to release past or present information requested, including or not limited to past drug and alcohol test results. I release all providers of said information from any liability stemming from release of same information.

I understand that as an employee at will, I have the right to terminate my employment at any time and therefore Lieber Construction/Bridgeport Materials has the same right.
Date

MonthDayYear
Date
Signature

Clear
Should be Empty: