Application

Employment History
Provide the following information of your past four (4) employers, assignments or volunteer activities, starting with the most recent.
MOST RECENT
From
MM
DD
YYYY
To
MM
DD
YYYY
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
MM
DD
YYYY
To
MM
DD
YYYY
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
MM
DD
YYYY
To
MM
DD
YYYY
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
MM
DD
YYYY
To
MM
DD
YYYY
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 and 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

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*
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.
Consent for Drug Testing*
By checking this box I agree that I have been fully informed of the reason for this urine test for drugs and do hereby freely give my consent. In addition, I understand that the results of this test will be forwarded to my potential employer and become part of my record.

If this test is positive or if I refuse to submit to this test, I understand that I cannot reapply with this company for a period of 90 days. If after 90 days I reapply for employment with this company and either test positive or refuse to submit to this test, I understand that I cannot reapply with this company for a period of 12 months.

I hereby authorize my test results to be released to Larry Jacinto Construction, Inc. My test results will not be released to any other parties without my written authorization.

I certify that I have read, fully understand and accept all terms of the foregoing Consent for Drug Testing
Signature*

Application for Employment

Step 1 of 5

Contact Information

Questions

Employment History

Skills and Qualifications

Educational Background (If job related)

References

File Attachment

SERVICES