Newcomb Construction Application for Employment
Pre-Employment Questionnaire | Equal Opportunity Employer
Name (Last, First) *
Your answer
Date *
MM
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DD
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YYYY
Present Address *
Your answer
Permanent Address (if different)
Your answer
Phone Number *
Your answer
Secondary Phone Number
Your answer
Email Address
Your answer
Referred By
Your answer
Desired Position *
Your answer
Desired Salary *
Your answer
Date you can start *
MM
/
DD
/
YYYY
Are you employed now? *
May we contact your present employer?
Are you legally authorized to work in the US?
Ever applied to this company before?
If so, when?
MM
/
DD
/
YYYY
High School attended *
Please include years attended, subjects studied, and if you graduated.
Your answer
College attended
Please include years attended, subjects studied, and if you graduated.
Your answer
Trade or Correspondence School attended
Please include years attended, subjects studied, and if you graduated.
Your answer
Subject of Special Study
Your answer
Special Training
Your answer
Special Skills
Your answer
US Military or Naval Service
Your answer
Rank
Your answer
Former Employer #1 *
Please include business name, address, position, salary, dates employeed, and reason for leaving.
Your answer
Former Employer #2
Please include business name, address, position, salary, dates employeed, and reason for leaving.
Your answer
Former Employer #3
Please include business name, address, position, salary, dates employeed, and reason for leaving.
Your answer
Reference Person #1 *
Please include name, business name, address, and years known.
Your answer
Reference Person #2 *
Please include name, business name, address, and years known.
Your answer
Reference Person #3 *
Please include name, business name, address, and years known.
Your answer
Authorization *
By checking the box below, you agree that the facts above are true and complete to the best of your knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. You authorize investigation of all statements contained herein and the references and employers listed above to give Newcomb Construction any and all information concerning your previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. You also understand and agree that no representative of Newcomb Construction has any authority to enter into any agreement for employment for any specified time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Amercans with Disabilities Act (ADA) and other relevant federal and state laws.
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