Job application

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Title *

Last name *

Middle Name *

First name *

Address line 1

Address line 2

City *

State *

ZipCode *

Email *

Phone number *

Desired Rate of Pay: - Per Hour *

Have you ever been employed under another name? *

YesNo

If Yes, Other Name

If you are under 18, can you furnish a work permit?

YesNo

Have you ever been employed here before? *

YesNo

Are you legally authorized to work in this country? *

YesNo

Date Available for Work *

Type of employment desired *

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

YesNo

Have you been convicted of a crime in the last (7) Years? *

YesNo

If yes, please explain

Driver's License Number *Only if you apply for job that requires you to drive in daily tasks

License State *

Driver's License Type *

E (Regular)BA

Position you are applying for: *

Do you have prior experience in this position? *

YesNo

Please write the details below

Previous Employment Information Please list your last four employers, assignments or volunteer activities, starting with the most recent, including military experiences.

Job 1 Information

Job 1 From Date *

Job 1 To Date *

Employer *

Telephone

Job Title *

Address *

City *

State *

ZipCode *

Immediate Supervisor & Title *for recommendations purposes

Contact phone *

Brief summary of work performed and job responsibilities *

Reason for Leaving *

Hourly Salary or Hourly Starting Amt. $

Hourly Salary or Hourly Ending Amt. $

Job 2 Information

Job 2 From Date *

Job 2 To Date *

Employer *

Telephone

Job Title *

Address *

City *

State *

ZipCode *

Immediate Supervisor & Title *for recommendations purposes

Contact phone *

Brief summary of work performed and job responsibilities(duplicate) *

Reason for Leaving *

Hourly Salary or Hourly Starting Amt. $

Hourly Salary or Hourly Ending Amt. $

Job 3 Information

Job 3 From Date *

Job 3 To Date *

Employer *

Telephone

Job Title *

Address *

City *

State *

ZipCode *

Immediate Supervisor & Title *for recommendations purposes

Contact phone *

Brief summary of work performed and job responsibilities(duplicate)(duplicate) *

Reason for Leaving *

Hourly Salary or Hourly Starting Amt. $

Hourly Salary or Hourly Ending Amt. $

Job 4 Information

Job 4 From Date *

Job 4 To Date *

Employer *

Telephone

Job Title *

Address *

City *

State *

ZipCode *

Immediate Supervisor & Title *for recommendations purposes

Contact phone *

Brief summary of work performed and job responsibilities(duplicate)(duplicate)(duplicate) *

Reason for Leaving *

Hourly Salary or Hourly Starting Amt. $

Hourly Salary or Hourly Ending Amt. $

Skills and Qualifications Summarize any training, skills, licenses, certificates and/or characteristics of yourself that may qualify you as being able to perform functions for the position which you are applying.

Skills and Qualifications Response *

Educational Background

High School Education InformationPlease enter High School Name, Location, Number of Years Completed, Did you Graduate?, Course of Study (if Applicable)

College Education InformationPlease enter High School Name, Location, Number of Years Completed, Did you Graduate?, Course of Study (if Applicable)

Other Education (i.e. Trade School)Please enter High School Name, Location, Number of Years Completed, Did you Graduate?, Course of Study (if Applicable)

References-Business Relationships

Reference 1 Name

Reference 1 Phone Number

Years Known

Reference 2 Name

Reference 2 Phone Number

Years Known

Reference 3 Name

Reference 3 Phone Number

Years Known

I attest that I am not covered by any covenants not to compete, non-disclosure agreements or confidentiality agreements that would interfere with employment by The Women's Fund for Health, Education & Resolution if I were accepted for employment with the company. I further understand that if l am hired by The Women's Fund for Health, Education & Resolution, I may be required to sign and comply with a The Women's Fund for Health, Education & Resolution Non-Disclosure agreement and that there are certain documents relating to confidentiality and Company policies that I may be expected to execute.

I attest to the truth and accuracy of all information I have provided on this application, and it is understood and agreed that any misrepresentation by me or omissions of fact on this application will be sufficient cause for rejection of my application and/or termination of my employment, if l have become employed. I further attest that I am able to meet the physical requirements of the position I am applying for without restrictions of any kind. I give the company the right to investigate all references and to secure additional information about me, if job-related. I hereby release the company and its representatives from any liability for seeking such information, as well as all other persons, corporations, or organizations for furnishing such information to the company. The company is an equal opportunity employer and will not base hiring decisions on race, sex, national origin, religion, disability, age, or any other protected characteristic under applicable local, state, or federal laws. The company does not discriminate in employment and no question on this application is used or intended to be used for the purpose of limiting or excluding any applicant's consideration for employment on any basis prohibited by applicable local, state, or federal law. This application is current for only 180 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application. I understand that the company is an "employer at-will" and that if I become employed by the company just as I will be free to resign at any time, the employer reserves the right to terminate an employment at any time, with or without cause and with/without prior notice. I understand that at no representative of this company has the authority to make any assurance to the contrary. I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of this person's need for an accommodation that would be required by the ADA

Signature *By Typing in Your Name you attest that all information provided it true and correct.

Date Completed *

Seminole Asphalt Paving, Inc. Application for Employment

Job application

Information

Contact Us

Phone # (407) 323-0111

Fax # (407) 323-2003