Name *

First Name

Last Name

Phone

(###)

###

####

If you are under 18, and it is required, can you furnish a work permit?

Yes

No

Have you ever been employed here before? *

Yes

No

Is this application a request for reemployment following an extended military leave of absence from this company?

Yes

No

Are you legally eligible for employment in this country? *

Yes

No

Date available for work *

MM

DD

YYYY

Type of employment desired: *

Full-Time

Part-Time

Temporary

Seasonal

Educational Co-Op

Are you able to perform "essential functions" of the ojb for which you are applying? (with or without reasonable accommodation)? *

This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

Yes

No

Need more information about the job's "essential functions" to respond

Do you hold a valid driver's license? (only if driving may be required for the job in which you are applying)

License number will be collected at a later date.

Yes

No

Have you ever pleaded "guilty" or "no contest" to, or been convicted of, a crime?

Answering "yes" to either part of the following question does not constitute an automatic bar to employment. Factors such as the date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

Yes

No

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

May we contact for reference?

Yes

No

Later

Starting Date of Employment

MM

DD

YYYY

Ending Date of Employment

Leave blank if still employed

MM

DD

YYYY

Hourly or Salary

Hourly

Salary

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

May we contact for reference?

Yes

No

Starting Date of Employment

MM

DD

YYYY

Ending Date of Employment

MM

DD

YYYY

Hourly or Salary

Hourly

Salary

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

May we contact for reference?

Yes

No

Starting date of employment

MM

DD

YYYY

Ending date of employment

MM

DD

YYYY

Hourly or Salary

Hourly

Salary

Computer Skills

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Microsoft Project

Email

Internet

Adobe Acrobat

Completed

Masters

Bachelors

Associates

Diploma

GED

Certification

Other

Completed

Masters

Bachelors

Associates

Diploma

GED

Certification

Other

Completed

Masters

Bachelors

Associates

Diploma

GED

Certification

Other

Name

First Name

Last Name

Phone

(###)

###

####

Name

First Name

Last Name

Phone

(###)

###

####

Name *

First Name

Last Name

Phone

(###)

###

####

Applicant Statement *

I certify that all information I have provided in order to apply for and secure work with Genesee Construction Service is true, complete and correct.. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an 1-9 Form in this regard. This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status. The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.