Applicant Information

It is the policy of Heiler Painting to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, creed, age, sex, gender, gender identity, ancestry, national origin, marital status, civil union status, domestic partnership status, veteran’s status, sexual orientation, disability, genetic information, citizenship, or any other protected status. I also understand that Heiler Painting will consider reasonable accommodations for any applicant or employee with a handicap or disability who requests a reasonable accommodation during the application/interview process or during employment.

Applicant Full Name *
Street Address *
City *
State *
Zip Code *
Number of Years at This Address *
Home Phone *
Mobile Phone *
Email Address *
Are You 18 Years or Older? *
If hired, are you able to submit proof that you are legally eligible for employment in the United States? *
Do you have a valid driver’s license? *
Job Information
Job Position Applied For *
Employment Type *
Availability (check all days that you can work) *
SundayMondayTuesdayWednesdayThursdayFridaySaturday
Are you able to work weekends if necessary? *
If no, please state any limitations
Desired Salary (e.g $/per hour) *
Desired Start Date *
Have you applied to our company previously? *
If yes, when?
How were you referred to our company? *
Do you have any friends or relatives who work here? If yes, please list here. *
Are you able to perform the essential functions of the job position you seek with or without reasonable
accommodation?
What reasonable accommodation, if any, would you request? *
Applicant Skills

Check those skills that you have. List any other skills that may be useful for the job you are seeking. Enter the number of years of experience, and check off the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)

CARPENTRY

Years of Experience *
Rating (e.g. 5 is the highest rating) *

PAINTING

Years of Experience *
Rating (e.g. 5 is the highest rating) *

SALES

Years of Experience *
Rating (e.g. 5 is the highest rating) *

OTHER SKILLS

Please describe other skills you have in more detail *
Can you speak/read any language other than English? *
If yes, please describe in more detail
Applicant Employment History

List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment.

EMPLOYER #1

Employer Name *
Supervisor Name *
Street Address *
City *
State *
Zip Code *
Job Title *
Reason for Leaving *
Start Date *
End Date *

EMPLOYER #2

Employer Name
Supervisor Name
Street Address
City
State
Zip Code
Job Title
Reason for Leaving
Start Date
End Date

EMPLOYER #3

Employer Name
Supervisor Name
Street Address
City
State
Zip Code
Job Title
Reason for Leaving
Start Date
End Date
Applicant Education and Training
Check the Highest Grade Completed *

789101112College

HIGH SCHOOL

Name of High School *
City/State *
Did You Graduate? *
Years Attended *

COLLEGE

Name of College
City/State
Degree
Years Attended

OTHER

Please describe other education, training, and relevant skills you have in more detail
Applicant References

List any two business references (non- relatives) who would be willing to provide a reference for you.

REFERENCE #1

Name *
Phone Number *
Email Address *
Relationship *

REFERENCE #2

Name *
Phone Number *
Email Address *
Relationship *
Applicant Resume
Certification

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize Heiler Painting to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its CEO, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Heiler Painting, except in a specific written contract of employment signed on behalf of the organization by its CEO, has the power to alter or vary the voluntary nature of the employment relationship.

Electronic Signature *


I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS