General Information First Name            Last Name

Address  
City       State       Zip Code  

Daytime Phone      Evening Phone

Email

Please complete the following. Yes No
Do you possess a valid Pennsylvania Driver's License?
    If yes, please give the operator's number    
Do you possess a valid Commercial Driver's License (CDL)?
   If yes, do you have any endorsements?
          If yes, please list    
   If yes, do you have any restrictions?
          If yes, please list    
Do you have a Pesticide License?
   If yes, please give the class    
Do you have your own transportation?
Can you drive a standard transmission vehicle?

 

Education
  Name City, State Degree Dates Enrolled
High School
College
Vo-tech
Military
Other

Awards/Honors

Hobbies/Sports

 

Work Experience (starting with most recent) 1. Employer Name           Contact Person

Address                           
City       State       Zip Code  

Phone      Start Date      End Date

Job Title      Wage      Reason for Leaving

 

2. Employer Name           Contact Person

Address                           
City       State       Zip Code  

Phone      Start Date      End Date

Job Title      Wage      Reason for Leaving

 

May we contact your present employer?    yes        no

Please list your skills and abilities as related to the position.

 

References (no relatives please) 1. Name           Occupation

Address                           
City       State       Zip Code  

Phone   

 

2. Name           Occupation

Address                           
City       State       Zip Code  

Phone   

 


Position Information I will be available for work starting            Anticipated Starting Wage

Position applying for Hold Ctrl to select more than one area of interest.

Additional Comments


 "The Equal Employment Opportunity Commission (EEOC) has issued guidelines setting forth the Commission's interpretation regarding sexual harassment as a violation of Title VII of the Civil Rights Act of 1964. These guidelines are consistent with our long-standing policy that conduct creating an intimidating, hostile or offensive working environment will not be tolerated and those violating this practice may be subject to disciplinary action up to and including discharge. Any employee who feels that he or she is being subject to sexual or racial harassment, is urged to immediately contact the employee relations department.

I understand and agree that:

1. Any material misrepresentation or deliberate omission of a fact in my application may be justification for refusal of, or if employed, termination from employment.

2. It is my understanding that the company will make a thorough investigation of my entire work and personal history and may verify all data given in my application for employment, related papers, or oral interviews. I authorize such investigation and the giving and receiving of any information requested by the company and I release from liability any person giving or receiving any such information. I understand that falsification of data so given or other derogatory information discovered as a result of this investigation may prevent my being hired, or if hired, may subject me to immediate dismissal.

3. I agree that my employment may be terminated by this Company at any time without liability for wages or salary except such as may have been earned at the date of such termination. If requested by the management at any time, I agree to submit to search of my person or of any locker that may be assigned to me, and I hereby waive all claims for damages on account of such examination. I understand and agree that I may be required to take physical examination, at company expense, at any time to determine if I am physically fit for the job I am to perform, and, I authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the duties of a job I am being considered for prior to employment or in the future during my employment with the company.

4. Although management makes every effort to accommodate individual preferences, business needs may at times make the following conditions mandatory; overtime, shift work, a rotating work schedule, or a work schedule other than Monday through Friday. I understand and accept these as conditions of my continuing employment.

I further understand that this is an application for employment and that no employment contract is being offered.

I understand that if I am employed, such employment is for an indefinite period of time and that the company can change wages, benefits and conditions at any time.

Did you read and understand the above?     yes     no

Did you fill out this application yourself?     yes     no

Signed (please type your name)      Date
 

Pennsylvania Home Improvement Registration Number  PA8613

Eichenlaub, Inc., P.O. Box 111282, Pittsburgh, PA  15238    412-767-4769

Copyright ©   Eichenlaub, Inc.  All Rights Reserved.  Last modified: 01/27/10