All fields marked with an asterisk (*) must be filled out.

Please check the box at the bottom acknowledging your consent to the terms and limitations.

Personal Information

Your name*

Your email*

Phone Number*

Address*

City*

State*

Zip Code*

What position are you applying for?*

When can you start?*

Are you currently employed?*

YesNo

Are you 18 years of age or older?*

YesNo

Education History

High School

School Name

Location

Years Attended

Subjects Studied

Did you Graduate?

YesNo

Trade School

School Name

Location

Years Attended

Subjects Studied

Did you Graduate?

YesNo

College / University

School Name

Location

Years Attended

Subjects Studied

Did you Graduate?

YesNo

Other Education and Skills

Enter any other relevant education, training, or skills

Employment History

Please list below your 3 most recent former employers, starting with the last one first.

Employer #1

Start Date?*

End Date?*

Employer Name*

Employer Address

Salary

Position*

Reason for Leaving*

Employer #2

Start Date?*

End Date?*

Employer Name*

Employer Address

Salary

Position*

Reason for Leaving*

Employer #3

Start Date?*

End Date?*

Employer Name*

Employer Address

Salary

Position*

Reason for Leaving*

References

Give the names of three persons not related to you, whom you have known at least one year

Reference #1

Name

Address

Phone

Business

Years Acquainted

Reference #2

Name

Address

Phone

Business

Years Acquainted

Reference #3

Name

Address

Phone

Business

Years Acquainted

Employment Questionnaire

Why did you leave your last job*

Have you ever used another name in your work?*

YesNo

Are you a US Citizen?*

YesNo

Do you wish to voluntarily identify yourself as a veteran for reporting purposes?*

YesNo

Have you ever been convicted of a felony?*

YesNo

Date of Conviction

Do you have any felony charges currently pending?*

YesNo

What are the exact charges

Have you ever been convicted for illegal drug use?*

YesNo

ALL JOB APPLICANTS WHO ARE SELECTED FOR EMPLOYMENT MUST SUBMIT TO A DRUG TEST. REFUSAL TO SUBMIT OR A POSITIVE CONFIRMED DRUG TEST MAY BE USED AS A BASIS FOR REFUSAL TO HIRE THE APPLICANT.

I CERTIFY THAT ALL INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION.

IN CONSIDERATION OF MY EMPLOYMENT, I AGREE THAT I WILL NOT COMMENSE ANY ACTION OR SUIT OR ASSERT ANY CLAIMS RELATED TO MY EMPLOYMENT WITH BRAZEN & GREER MASONRY, INC., WHETHER SUCH CLAIMS ARE BASED ON FEDERAL OR STATE COMMON LAW OR STATUTORY LAW (INCLUDING CIVIL RIGHTS LAWS) MORE THAN SIX MONTHS AFTER THE EARLIER OF THE DATE OF THE TERMINATION OF EMPLOYMENT OR THE DATE ON WHICH THE CLAIM ACCRUED. IF A SHORTER PERIOD OF LIMITATIONS APPLIES UNDER THE LAW, THAT PERIOD WILL THEN GOVERN. I EXPRESSLY WAIVE ANY LONGER STATUTE OR OTHER PERIOD OF LIMITATIONS TO THE CONTRARY.

- Do you accept the terms and limitations outlined above?*

Signature*

Signature Date *