First Name

Last Name

State

Zip Code

HOW DO YOU PREFER TO BE CONTACTED?

Call Text Email

Phone Number

Date

Preferred Date

Preferred Time

Service Type

Message

Contractor Application

Step 1 of 7

Name

First Last

Name

First name MI Last name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home phone number

Work phone number

Facsimile number

E-mail address

Social security number

Driver’s license number/state/expiration

(if job involves any driving)

Contract Desired

Position applied for

How did you hear about this position?

Date available for work

Desired hours (full time, part time, etc.)

Education

High School

Name and Address of School

Course of Study

Total Years of Study

Degree/ Diploma

Undergraduate College

Name and Address of School

Course of Study

Total Years of Study

Degree/ Diploma

Graduate/Professional

Name and Address of School

Course of Study

Total Years of Study

Degree/ Diploma

Other (Specify)

Name and Address of School

Course of Study

Total Years of Study

Degree/ Diploma

List any seminars, classes or other education not listed above which may help qualify you for this position (if you need additional space, please use page 7):

Contractor Application

Employment History

List below all present and past employers over the past ten years, starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume. May we contact your current employer?

Yes

1.

Employer (Current)

Yes

Start Date

End Date

Essential job functions of final position

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Starting Salary

Ending Salary

Phone number

Fax number

Supervisor(s)

First Last

Job position(s)

E-mail address of supervisor

Reason(s) for leaving

What value did you add to this company or its customers?

2.

Employer

Start Date

End Date

Essential job functions of final position

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Starting Salary

Ending Salary

Phone number

Fax number

Supervisor(s)

First Last

Job position(s)

E-mail address of supervisor

Reason(s) for leaving

What value did you add to this company or its customers?

Contractor Application

Employment History

3

Employer

Start Date

End Date

Essential job functions of final position

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Starting Salary

Ending Salary

Phone number

Fax number

Supervisor(s)

First Last

Job position(s)

E-mail address of supervisor

Reason(s) for leaving

What value did you add to this company or its customers?

Pre-onboarding interview

References

List below three persons not related to you who have knowledge of your work performance within the last 5 years

Name

First Last

Occupation

Company name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone

E-mail

Relationship & years acquainted

Untitled

Section Break

Name

First Last

Occupation

Company name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone

E-mail

Relationship & years acquainted

Section Break

Name

First Last

Occupation

Company name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone

E-mail

Relationship & years acquainted

Additional Space

Additional space provided to expand on any points or questions asked previously in this application

Contractor Application

Please read each statement closely and initial each acknowledging your understanding

Equal Employment Opportunity Statement

This company is committed to the principles of equal employment opportunity and is committed to make employment decisions based on merit. We are committed to complying with all Federal, State and local laws providing for equal employment opportunities, as well as all laws related to terms and conditions of employment. The Company desires to maintain a work environment that is free of sexual harassment and discrimination due to race, religion, color, national origin, physical or mental disability, age or any other status protected by Federal, State or local laws. The Company will make reasonable efforts to accommodate those physical or mental limitations of an otherwise qualified employee unless undue hardship would result for the company.

Discrimination and Sexual Harassment Policy Statement

This Company will not tolerate any form of unlawful discrimination, including sexual harassment. Any employee who engages in unlawful discrimination or sexual harassment will be subject to appropriate discipline, up to and including termination. Prohibited sexual harassment is defined as follows: Unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature constitutes sexual harassment when (1) submission to such conduct is made whether explicitly or implicitly a term or condition of an individual’s employment; (2) Submission to or action of such conduct by an individual is used as the basis for employment decisions affecting such individuals; or (3) Such conduct has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile or offensive work environment.

Disclosure to Applicants Concerning Drug/Alcohol Testing

If you are offered a position with the Company, you may be given a drug/alcohol test as a condition of employment. Your refusal to timely submit to a drug/alcohol test or your failure to pass such a test means you will not be employed by this company. Neither the collector of specimens nor the medical professional who reviews the test results will be a company employee. The test results will be kept confidential. The individual undergoing testing will not be directly observed while providing the specimen unless there are reasonable grounds to believe the individual may alter or substitute the specimen. Negative test results are required as a condition of employment.

Complete and Accurate Information

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission or misstatement of material fact on this application, or any other document used to secure employment, shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

At-Will Employment

I understand and agree that if I am employed, my employment will be “at-will”, which means that the Company may terminate the employment relationship at any time, with or without cause and with or without notice. Likewise, the Company will respect my right to terminate my employment at any time, with or without cause and with or without notice. I further understand that any prior representation, whether expressed or implied to the contrary is hereby superceded and that no promise or representation contrary to the foregoing is binding on the Company unless made in writing and signed by the Company’s president.

Testing Authorization

If offered a position with the Company, I hereby agree to any legally permitted physical, psychological, skill, drug or medical test required by the Company as a condition of employment.

Investigation Authorization

I authorize investigation into all statements and references contained in this application. Said investigation may include credit, driving, criminal background, references and other background checks. By applying for this job, I also authorize post-hire investigation into my credit, driving and criminal background.

Company Obligation

I understand and agree that the Company’s acceptance of this job application does not mean that a position for which I am qualified is open (unless specifically posted) or that the company has agreed to hire me. I understand that the Company is under no obligation to hire me as the result of accepting this completed application.

I HAVE READ AND UNDERSTAND THE ABOVE POLICY STATEMENTS AND AGREE TO BE BOUND BY THEM IF EMPLOYED BY THE COMPANY.

Signature

Date

Book An Appointment

Contract Desired

Education

Contractor Application

1.

2.

Contractor Application

3

Pre-onboarding interview form

Pre-onboarding interview

Pre-onboarding interview

Section Break

Section Break

Additional Space

Contractor Application

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