Employment Application
Please complete the entire application.
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1. Employer Information
Diplomat Construction & Demolition, Inc.
316 E Union Street
West Chester, Pennsylvania 19382
(484) 887-0853
It is the policy of Diplomat Construction & Demolition, Inc. to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.
2. Applicant Information
Applicant Full Name:
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Your answer
Home Address:
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City/State/ZIP:
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Your answer
Number of years at this address:
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Daytime phone:
Your answer
Evening phone:
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Mobile phone:
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Your answer
Social Security Number:
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Driver's License (State/Number):
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3. Emergency Contact
Who should be contacted if you are involved in an emergency?
Contact Name:
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Relationship to you:
Your answer
Address:
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City/State/ZIP:
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Daytime phone:
Your answer
Evening phone:
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4. Job Position Applied For:
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Full or Part Time?
Full time
Part time
Clear selection
What is your current rate of pay?
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Your answer
What is your expected rate of pay?
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Your answer
5. Are you at least 18 years old?
Yes
No
Clear selection
7. Are you willing to work any shift, including nights and weekends?
Yes
No
If no, please state any limitations:
Your answer
8. If applicable, are you available to work overtime?
Yes
No
Clear selection
9. If you are offered employment, when would you be available to begin work?
Your answer
10. If hired, are you able to submit proof that you are legally eligible for employment in the United States?
Yes
No
Clear selection
11. Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation?
Yes
No
Clear selection
What reasonable accommodation, if any, would you request?
Your answer
12. Applicant's Skills
List any skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)
Do you have a current OSHA 10 certification?
*
Yes
No
Skill:
Your answer
Years of Experience:
Your answer
Ability/Rating
Choose
1
2
3
4
5
Skill:
Your answer
Years of Experience:
Your answer
Ability/Rating
Choose
1
2
3
4
5
Skill:
Your answer
Years of Experience:
Your answer
Ability/Rating
Choose
1
2
3
4
5
13. Application Employment History:
List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment.
Employer Name:
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Supervisor Name:
Your answer
Address:
Your answer
City/State/ZIP:
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Job Duties:
Your answer
Reason for Leaving:
Your answer
Dates of Employment (Month/Year):
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Employer Name:
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Supervisor Name:
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Address:
Your answer
City/State/ZIP:
Your answer
Job Duties:
Your answer
Reason for Leaving:
Your answer
Dates of Employment (Month/Year):
Your answer
Employer Name:
Your answer
Supervisor Name:
Your answer
Address:
Your answer
City/State/ZIP:
Your answer
Job Duties:
Your answer
Reason for Leaving:
Your answer
Dates of Employment (Month/Year):
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College/University Name and Address:
Your answer
Did you receive a degree?
Yes
No
In Progress
Clear selection
If yes, degree(s) received:
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High School/GED Name and Address:
Your answer
Did you receive a degree?
Yes
No
In Progress
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Other Training (graduate, technical, vocational):
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Please indicate any current professional licenses or certifications that you hold:
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Awards, Honors, Special Achievements:
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Military Service:
Yes
No
Clear selection
Branch:
Your answer
Specialized Training:
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15. References
List any two non-relatives who would be willing to provide a reference for you.
Name:
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Address:
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City/State/ZIP:
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Telephone:
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Relationship:
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Name:
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Address:
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City/State/ZIP:
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Telephone:
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Relationship:
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16. Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:
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17. General Information
Valid Driver's License?
*
Yes
No
Vehicle?
*
Yes
No
Tools?
*
Yes
No
If Yes, please list:
Your answer
Construction Background?
*
Yes
No
Steel Toe Boots?
*
Yes
No
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