Personal Information: (use tab key to move between fields)

Name:
Email:
Address:
City State Zip:
Driver's License #
Home Phone:
Social Security:
Cell or Msg:

Employment Desired:

Position applying for:
What days can you work?:
Can you work weekends?:
Can you work overtime?:
Do you have reliable transportation?:
Are you available for travel?:
If hired, what date can you start?:
Salary desired? $

Additional Personal Information:

List any friends or relatives you may have working at Diversified Painting:
Please tell us why you would like to work at Diversified Painting?:
Can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?:
Are you able to perform all the functions of the job for which you are applying?:
If no, please describe the functions that you can not perform:

NOTE: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.

Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? (Convictions for Marijuana-related offenses that are more than two years old need not be listed.):
 
If yes, state nature of the crime(s), when and where convicted and disposition of the case:
 

NOTE: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.

Do you speak and/or write another language?:
If so, which language(s)?:

Education and Training:

School
Address
# of Years
Graduate?
Degree
High School:
College:
Vocational:

Employment History:

Are you currently employed?:
If so, may we contact your current employer?:

List below all present and past employment starting with your most recent employer. Account for all periods or unemployment.


Current (or most recent) employer:

Name of employer:
Address:
Type of Business:
Telephone Number:
Supervisor's name:
Your position and duties:
Dates of employment:
Weekly Pay (Starting/Ending):
Reason for leaving:

Previous employer:

Name of employer:
Address:
Type of Business:
Telephone Number:
Supervisor's name:
Your position and duties:
Dates of employment:
Weekly Pay (Starting/Ending):
Reason for leaving:

Previous employer:

Name of employer:
Address:
Type of Business:
Telephone Number:
Supervisor's name:
Your position and duties:
Dates of employment:
Weekly Pay (Starting/Ending):
Reason for leaving:

Disclaimer and Authorization Statement: Please read the following four(4) paragraphs carefully. By clicking on the "submit" button you are agreeing to all the terms and conditions set-forth in each paragraph

By clicking the "submit" button below, I hereby authorize Diversified Painting Incorporated to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure.

By clicking the "submit" button below, I hereby agree to submit to binding arbitration all disputes and claims arising out of the submission of this application. I further agree, in the event that I am hired by Diversified Painting Incorporated, that all disputes that can not be resolved by informal internal resolution which might arise out of my employment with Diversified Painting Incorporated, whether during or after that employment, will be submitted to binding arbitration. I agree that such arbitration shall be conducted under the rules of the American Arbitration Association. This application contains the entire agreement between the parties with regard to dispute resolution, and there are no other agreements as to dispute resolution, either oral or written.

By clicking the "submit" button below, I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create any employment contract between me and Diversified Painting Incorporated. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or Diversified Painting Incorporated, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and Diversified Painting Incorporated's designated representative.