APPLICATION FOR EMPLOYMENT

George Nice and Sons
APPLICATION FOR EMPLOYMENT

POSITION APPLIED FOR:
If other:
COMPLETE AND SUBMIT APPLICATION
George Nice and Sons is an Equal Employment Opportunity Employer and its policy is to provide equal employment without regard to race, color, religion, sex, age, national origin, disability or veterans' status. This policy relates to, but is not limited to, all aspects of recruitment, employment, training, placement, promotion, demotion, transfer, layoff, recall, termination, rates of pay or other forms of compensation, and the use of all company facilities and participation in all Company sponsored employee activities.
PERSONAL INFORMATION
First Name:
Middle Name:
Last Name:
Street Address:
City:
State:
Zip:
Home Telephone
Cell Number
Business Telephone:

Do you have any relatives working at George Nice and Sons?	Yes \| No
If yes, give name, relationship and position:

Do you have your own transportation?	Yes \| No
Are you at least 18 years of age?	Yes \| No
Are you available to work fulltime?	Yes \| No
Are you available to work overtime?	Yes \| No
Have you ever worked for George Nice and Sons?	Yes \| No
If yes, give dates: to supervisor:
May we contact you at work?	Yes \| No
Have you been convicted of a felony within the past 10 years?	Yes \| No
(A positive response will not necessarily eliminate you from consideration.)
If yes, please explain:

Who do we contact in case of emergency?
Name:
Address:
City/State:
Home Telephone:
Business Telephone:
Are you eligible for employment in the United States? Yes \| No

SCHOOLS
Education: Did you graduate high school?	Yes \| No
Did you attend college, or vocational school?	Yes \| No
If so how many years?

List any certificates, cards, or licenses you hold or any trade associations to which you belong. Also list any specialized training you may have.

BEGIN WITH YOUR PRESENT OR MOST RECENT EMPLOYER
EMPLOYMENT:
Company Name:		Telephone:
Address:		Dates of Employment:
Name of Supervisor:		Annual Rate of Pay:
Job Title/Description:
Reason For Leaving:

EMPLOYMENT 2:
Company Name:		Telephone:
Address:		Dates of Employment:
Name of Supervisor:		Annual Rate of Pay:
Job Title/Description:
Reason For Leaving:

SKILLS:
List any job related skills you have ( Include equipment, special tools, pc software, etc.):	Years of Experience:

REFERENCES:
Name & Address	Occupation	Relationship	Telephone Numbers

Additional comments which you feel would be important in our consideration of your application:

Work Activity Requirements:
I acknowledge that the activities required to be performed on a daily basis include, but are not limited to, the following:

Heavy Lifting (100 lbs.+)	Manual Labor (shoveling, raking, etc.)
Operating Power Tools (chainsaw, jack hammer)	Driving Company Vehicles (if approved by Insurance Co.)
Working Around Utilities (Va. Power lines, C&P cables, etc.)	Working with Chemicals (concrete mixes, gas mixtures, etc.)
Using Hand Tools (hammers, screw drivers, etc.)	Working with Hazardous Materials (gasoline, oil, etc.)
Working Around Sewage (septic waste)	Able to use a Respirator if required.

Do you know of any pre-existing conditions or health reasons that would prevent you from performing any of the above tasks. No | Yes
If yes: Please detail exceptions :

Please provide us with a copy of your driving record from the Division of Motor Vehicles. Thank you.

1. I acknowledge that my employment is contingent upon my satisfactory completion of the pre-employment physical and drug/alcohol testing. I further acknowledge that the company policy prohibits the use of any illegal drugs or being under the influence of prescription medication or alcohol during working hours.

2. This company has a zero tolerance drug abuse program. Any employee who produces a positive test during random or selective drug testing with be immediately terminated from employment with this company.

3. All of the information that has been provided on the application is true to the best of my knowledge. I authorize the above person or persons to investigate any part or all information provided above. I also know that if any of the above mentioned is misleading that it will result in the termination of my employment with the above listed company.

4. The employment relationship between the Company and the employee is an at will relationship. The employment relationship and compensation can be terminated, with or without cause, and with or without notice at any time, at the option of either the Company or the employee.

|
Or print this page and submit by mail or fax.