Application

Contact Information

Applicants are considered for all positions without regard to race, color, religion, sex, nation origin, age, marital or veteran status, or the presence of a non-job-related medical condition or handicap.

Date(Required)

Position Applied For(Required)

Name

First Middle Last

Social Security #

E-mail Address

Telephone #

Mobile/Beeper/Other Phone #

Address

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

Questions

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

Yes

No

If no please explain

Have you ever been employed here before?

Yes

No

If yes, give dates and positions

Are you legally eligible for employment in this country?

Yes

No

Date available for work

What is your desired salary range?

Type of employment desired

Full-TIme

Part-TIme

Temporary

Seasonal

Educational Co-Op

Are you able to meet the attendance requirements of the position?

Yes

No

Have you ever pled “guilty” or “no contest” to, or been convicted of a crime?

Yes

No

If yes, please provide date(s) and details

Answering “Yes” to these questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

Driver’s license number and State if driving is an essential job function

Employment History

Provide the following information of your past four (4) employers, assignments or volunteer activities, starting with the most recent.

MOST RECENT

From

To

Employer

Telephone #

Starting job title / Final job title

Address

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

Immediate supervisor and title:

Summarize the nature of work performed and job responsibilities

May we contact for reference?

Yes

No

Later

Reason for leaving:

Hourly Rate/Salary

Start $ / per

Final $ / per

SECOND MOST RECENT

From

To

Employer

Telephone #

Starting job title / Final job title

Address

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

Immediate supervisor and title:

Summarize the nature of work performed and job responsibilities

May we contact for reference?

Yes

No

Later

Reason for leaving:

Hourly Rate/Salary

Start $ / per

Final $ / per

THIRD MOST RECENT

From

To

Employer

Telephone #

Starting job title / Final job title

Address

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

Immediate supervisor and title:

Summarize the nature of work performed and job responsibilities

May we contact for reference?

Yes

No

Later

Reason for leaving:

Hourly Rate/Salary

Start $ / per

Final $ / per

FOURTH MOST RECENT

From

To

Employer

Telephone #

Starting job title / Final job title

Address

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

Immediate supervisor and title:

Summarize the nature of work performed and job responsibilities

May we contact for reference?

Yes

No

Later

Reason for leaving:

Hourly Rate/Salary

Start $ / per

Final $ / per

AN EQUAL OPPORTUNITY EMPLOYER M/F/V/H

Skills and Qualifications

Summarize any training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the positions for which you are applying.

Educational Background (If job related)

High School Name & Location

Number of years completed

Did you graduate?

College Name/Location

# of years completed

Major/Degree

Course of study

Other

# of years completed

Did you graduate?

Course of study

References

Reference #1 Name

Phone Number

Number of years known

Reference #2 Name

Phone Number

Number of years known

Reference #3 Name

Phone Number

Number of years known

File Attachment

Attach Resume/Files

If you have a resume and would like to include it, please submit here.

Drop files here or

Max. file size: 512 MB, Max. files: 5.

Special Employment Notice to Veterans, Vietnam Veterans, and Individuals with Physical or Mental Handicaps.

Government contractors are subject to 38 USC2012 of the Vietnam Era Veterans Readjustment Act of 1974 which requires that they take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals. If you are a disabled veteran, or have a physical or mental handicap, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job to the best of your ability in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect your consideration of employment. If you wish to be identified, please mark below:

Handicapped Individual

Disabled Veteran

Vietnam Era Veteran

Applicant Statement(Required)

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in my respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered. I understand that I am required to abide by all rules and regulations of this Company.

I expressly authorize, without reservation, the employer, it’s 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 such information in the employment process and all other persons, corportations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and 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 defined duration. I understand that no supervisor or representative of the employer is authorized to make any assurance 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 authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

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

If you are offered and accept employment with Larry Jacinto Construction, Inc., in the interest of safety for all concerned, you will be required to pass a urine test for drug use.

Signature(Required)

(909) 794-2151

9555 Wabash Ave, Redlands, CA

Contact Information

Questions

Employment History

Skills and Qualifications

Educational Background (If job related)

References

File Attachment

Services