Employment Application - Booms Stone Company

Employment History
Provide the following information for your past and current employers, assignments, or volunteer activities, starting with the most recent. Explain any gaps in employment in the comments section below. Most Recent Employer:
Employer:
Phone Number
Employment Start Date
MM slash DD slash YYYY
Employment Finish Date
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Hourly Rate/Salary:
Starting:
Ending:
Job Title:
Supervisor and Title:
Summarize the type of work and job responsibilities:
Reason for leaving:
May we contact for reference?
- Yes
- No
Give date:
Second Most Recent Employer:
Employer:
Phone Number
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employment Start Date
MM slash DD slash YYYY
Employment Finish Date
MM slash DD slash YYYY
Hourly Rate/Salary:
Starting:
Ending:
Job Title:
Supervisor and Title:
Summarize the type of work and job responsibilities:
Reason for leaving:
May we contact for reference?
- Yes
- No
Give date:
Third Most Recent Employer:
Employer:
Phone Number
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employment Start Date
MM slash DD slash YYYY
Employment Finish Date
MM slash DD slash YYYY
Hourly Rate/Salary:
Starting:
Ending:
Job Title
Supervisor and Title:
Summarize the type of work and job responsibilities:
Reason for leaving:
May we contact for reference?
- Yes
- No
Give date:
Forth Most Recent Employer:
Employer:
Phone Number
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employment Start Date
MM slash DD slash YYYY
Employment Finish Date
MM slash DD slash YYYY
Hourly Rate/Salary:
Starting:
Ending:
Job Title
Supervisor and Title:
Summarize the type of work and job responsibilities:
Reason for leaving:
May we contact for reference?
- Yes
- No
Give date:
SKILLS AND QUALIFICATIONS: Below, summarize any special training, licenses and/or certifications, or other skills that qualify you as being able to perform job related functions in the position for which you are applying.
Summarize:

Educational Background
List the last three schools attended. List number of years completed. Indicate certificate, degree or diploma earned, if any.
High School:
# of years completed:
Degree or diploma earned:
Year Graduated:
College
# of years completed:
Degree or diploma earned:
Year graduated:
Other
# of years completed:
Degree or diploma earned:
Year graduated:
References:
List name and telephone number of three business/work references who are NOT related to you and are NOT previous supervisors listed in the EMPLOYMENT section of this application. If not applicable, list three school or personal references who are NOT related to you.
Name
First Last
Phone
Years known
Name
First Last
Phone
Years known
Name
First Last
Phone
Years known
Additional Information
List professional, trade, business, or civic associations and any offices held. Exclude memberships which would reveal sex, race, religion, national origin, age, color, disability or any other similarly protected status.
Organization:
Office Held:
Organization:
Office Held:
Organization:
Office Held:
List computer skills and any other information you would like us to consider:
General Comments

Benefits And Employment Terms:
This position includes the following initial employee benefits: A. Paid vacation begins to accrue after 90 days from start date and according to the company handbook. B. Paid holidays after the first 90 days of full-time employment per company handbook. C. Paid sick days begin to accrue after 90 days from start date and according to the company handbook. D. Eligibility to participate in the 401K plan after the first year of full-time employment per company handbook. E. Eligibility to receive pension profit sharing bonus after the first year of employment per company handbook. F. Eligibility to receive health and dental benefits after 90 days per company handbook. The company pays for 50% of the single premium. If an employee wishes to insure other eligible family members, the employee must cover the additional cost of the insurance. The company reserves the right to increase or decrease their financial obligation for this benefit with 30 days notice. I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from the employer’s service, whenever it is discovered. The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or refusing any applicant from consideration on a basis prohibited by local, state, or federal law. The application is current for only 60 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application. 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 definite duration. I understand that no representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer. I understand it is this company’s policy not to refuse to hire a qualified individual with a disability because of that person’s need for a reasonable accommodation as required by the ADA. I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization. I will be required to pass a complete background check as well as a drug screen. I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.
I have read and understand the above listed benefits and terms.*
- Agree
- Disagree
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Step 1 of 4

BOOMS STONE COMPANY - EMPLOYMENT APPLICATION

Referral Source:

Personal Information

Employment History

Educational Background

References:

Additional Information

Benefits And Employment Terms: