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Employment Application

Online Employment Application

We understand this is a very long form to fill out. Please, try answer as many questions as possible. The more information we have certainly improves the possibility of being considered for employment.

The protection of your privacy is important to us at Industrial Painter .com. Rest assured that the personal information you provide us with, will not be disclosed to other parties and will be used solely for the purpose of evaluating suitability for employment.

Name
First Name
Middle Name
Last Name

Contact
Do you have a home phone?	Yes No
Home phone listed in your name?	Yes No
Phone
Alternate Phone
Cell Phone
Email Address

Current Address
Street
City
State
Zip
Years At Address

Prior Address (1)
Street
City
State
Zip
Years At Address

Prior Address (2)
Street
City
State
Zip
Years At Address

Eligibility
Will you be able to provide proof of eligibility to work in the U.S. if hired?	Yes No
Are you a U.S. Citizen?	Yes No
Social Security
Place Of Birth

Drivers License
If you have a valid driver's license a copy will be required prior to employment.
Do you have a valid drivers license?	Yes No
License Number
Issue Date
Exp Date
Endorsements
Restrictions, explain in detail:
Have you been arrested or convicted of a DUI or DWI?	Yes No
Number in last 10 years
DUI or DWI, please explain in detail
Have you received any tickets in 5 yrs?	Yes No
Number of tickets in last 5 years
Tickets, explain in detail:

Transportation
Do you own a vehicle?	Yes No
What type is your vehicle?	Car Truck Van Other
Make
Model
Mileage
Plate Number
Is your vehicle operational?	Yes No
If No, explain in detail:

Physical
Please list any physical limitations that prohibit you from performing the position applying for?
Do you have any physical limitations?	Yes No
If YES, explain in detail:
What can be done to accommodate your limitation?
Your Weight? (lbs)
Your Height? (ft) (in)
Are you afraid of heights?	Yes No
Any serious accidents or operations?
Details of any serious illnesses?

Emergency
In case of emergency the person to be notified:
Name
Street
City
State
Zip
Phone

Conviction Information
A conviction record will not necessarily be a bar to employment.
Have you ever been convicted of a felony or misdemeanor where disposition was a conviction, a plea of no lo contendere (no contest), or first offender treatment?	Yes No
If YES, explain in detail:
Have you ever had a professional license revoked, reviewed, suspended or limited in any way?	Yes No
If YES, explain in detail:

Employment Desired
Position For Applying
Date You Can Start
Desired Salary
Are you 18 years or older?	Yes No
Are you employed now?	Yes No
May we contact your present employer?	Yes No
Are you on layoff and subject to recall?	Yes No
Can you travel if the job requires it?	Yes No
Ever applied to this company before?	Yes No
Have you worked for this company before?	Yes No
If YES, explain in detail:
Have you ever been dismissed or asked to resign from any job?	Yes No
If YES, explain in detail:
Are you currently bound by a non competition, confidentiality or trade secret agreement?	Yes No
If YES, please explain in detail

Job-Related Skills
Do you have any special skills?	Yes No
If YES, explain in detail:
Do you have any special qualifications?	Yes No
If YES, explain in detail:
Do you have any special licenses, registrations or certifications?	Yes No
If YES, explain in detail:
Areas of your past position(s) which you have liked most and why:
Areas of your past position(s) which you have liked least and why:

Painting Experience
Have you ever painted industrial projects before?	Yes No
If YES, explain in detail:
Years at industrial painting
Have you ever painted commercial projects before?	Yes No
If YES, explain in detail:
Years at commercial painting
Have you ever painted residential projects before?	Yes No
If YES, explain in detail:
Years at residential painting
What is your previous painting experience?
What were your previous painting responsibilities?
Have you ever been self employed in the painting business?	Yes No
If YES, explain in detail:
Are you currently self employed?	Yes No
If YES, explain in detail:

Reference (1)
Please list three professional references, not related to you, whom you have known at least one year.
Name
Street
City
State
Zip
Phone
Years Acquainted

Reference (2)
Name
Street
City
State
Zip
Phone
Years Acquainted

Reference (3)
Name
Street
City
Zip
State
Phone
Years Acquainted

Most Recent Employer
Please list beginning with your present or most recent job. Include military service assignment and volunteer activities.
Name
Street
City
State
Zip
Phone
Position Held
Employed From ( Month / Year)
Employed To (Month / Year)
Years Employed
Pay Upon Leaving
Supervisor
Work Performed
Reason For Leaving

Prior Employer (1)
Name
Street
City
State
Zip
Phone
Position Held
Employed From ( Month / Year)
Employed To (Month / Year)
Years Employed
Pay Upon Leaving
Supervisor
Work Performed
Reason For Leaving

Prior Employer (2)
Name
Street
City
State
Zip
Phone
Position Held
Employed From ( Month / Year)
Employed To (Month / Year)
Years Employed
Pay Upon Leaving
Supervisor
Work Performed
Reason For Leaving

Elementary School
Name
Street
City
State
Zip
Years Completed
Graduate	Yes No
Diploma / Degree
Describe Course Of Study
Describe specialized training, skills extra-curricular activities

High School
Name
Street
City
State
Zip
Years Completed
Graduate	Yes No
Diploma / Degree
Describe Course Of Study
Describe specialized training, skills extra-curricular activities

College / University
Name
Street
City
State
Zip
Years Completed
Graduate	Yes No
Diploma / Degree
Describe Course Of Study
Describe specialized training, skills extra-curricular activities

Graduate / Professional
Name
Street
City
Zip
State
Years Completed
Graduate	Yes No
Diploma / Degree
Describe Course Of Study
Describe specialized training, skills extra-curricular activities

Company Manuals Agreement

This is to acknowledge that I have reviewed a copy of the online company manuals which I have read and fully understand. I have had the opportunity to ask management questions about parts of the manual that I did not understand fully. I agree, that if hired, I will follow these instructions while employed by this company. I agree, that if hired, I understand that my supervisor must see that these rules are complied with.

The information in the company manuals will increase your knowledge and awareness of the policies and procedures that have been established to ensure the most effective operation of the company. If hired you will be responsible for the performance of your work in the in the safest manner possible and in accordance with: All applicable local, state and federal laws, any and all safety policies and practices.

I understand failure to comply with the company manuals and/or OSHA safety act will result in termination.

I fully understand and agree

Yes

Drugs And Alcohol Agreement

I understand and agree that I may be required to take one or more: Physical Examination(s): Urine test(s) for drugs and alcohol, as a condition of hiring or continued employment. I agree to consent to take such test(s) at such time as designated by the company and to release the company, its directors, officers, agents or employees from any claim arising in connection with the use of test(s).

I fully understand and agree

Yes

Injury Reporting Agreement

I understand and agree that if i am injured while at work, I must report it immediately to my supervisor for proper first aid or medical care and before I receive any treatment. It is my responsibility to make sure a company accident report is filled out by my supervisor and signed by me the day of injury.

I fully understand and agree

Yes

Applicant's Certification Agreement

This application is not an employment contract but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law.

1. I authorize the investigation of all statements contained in this application and release from all liability any persons or employers supplying such information, and I also release the company from all liability that might result from making the investigation.

2. I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application (or on any required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.

3. I agree, if I am offered and accept a position, to conform to all existing and future Company rules and regulations and I understand that the Company reserves the right to change wages, hours and working conditions as deemed necessary. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL BE AT-WILL, MEANING THAT EITHER PARTY CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.

4. I understand that any employment offer is contingent upon my providing, within three (3) working days of employment, valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986.

5. I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.

6. I understand that by typing my name in the signature box below and submitting this application electronically, this becomes a legal and binding contract.

Type Name in Signature Box

Voluntary Request for Information

The following voluntary information is used to conduct background investigations prior to a employment offer. This information will not be maintained with your application nor will it be used in making the hiring decision.

Date of Birth (mm/dd/yyyy)

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Painting Employment Application

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