ࡱ>    !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNORoot EntryZ O2pFPCONTENTS CompObjVSPELLING e Initial, Last Name) Date Present Address (Street, City, State, Zip Code) Is This Your Permanent Address? If not, what is your permanent address? Home Phone: Cell Phone: Social Security #: Driver s License #: Do you have a valid driver s license? oYes oNo State Issued By: Do you have your own transportation? oYes oNo Do you have any objection to working overtime if necessary? oYes oNo Can you travel if required? oYes oNo Are you able to meet the drug-free work place requirement? oYes oNo Have you ever been convicted of a crime in the last 7 years? oYes oNo If yes, list convictions that are a matter of public record (a conviction will not necessarily disqualify you for employment): How were you referred to us? Have you previously applied for employment at CDH Painting, Inc.? oYes oNo Position(s) applying for or type of work desired: Type of employment desired: o Full-Time o Part-Time o Temporary Date you will be available to start work: If temporary, anticipated last day of work: Salary Required What do you like about painting? Skills or Special Training (summarize any job-related training, skills, licenses, certificates, and/or other qualifications): Employment History (List your employment history for the past 5 years or, if less than three employers in that time frame, your last three employers. Begin with current or most recent employment first. Include work related internships, military, and volunteer work. If your professional painting experience is not included, please attach additional sheets as needed.) Current Employer: Complete Address: Telephone #: May We Contact Your Employer: oYes oNo Immediate supervisor and title: Your Position Title: Salary: CHNKWKS #TEXTTEXTVZFDPPFDPP^FDPPFDPP`FDPPFDPPbFDPPFDPPdFDPPFDPPfFDPPFDPPhFDPPFDPPjFDPPFDPPlFDPCFDPCnFDPCFDPCpFDPCFDPCrFDPCFDPCtFDPCFDPCvFDPCFDPCxFDPCFDPCzFDPCFDPC|STSHSTSH~^STSHSTSH^~ Thank you for your interest in CDH Painting, Inc. As you may have heard, CDH Painting, Inc. is a great place to work! To ensure that your application is reviewed in a timely manner, please be sure to fill out the entire application, including: Contact names and current phone numbers for past employers At least three references Please be sure to initial each release and sign the application Fill out Background Check Release form After your application is received, you will hear back from us in about two weeks. If you are selected or an interview, you will be contacted by phone to schedule. After your interview, if you are still being considered to be hired, you will be required to take a post-offer drug test with our company s physician. A few pieces of information you may want to know about working for CDH Painting, Inc.: A typical work day begins at 8:00 AM and ends at 4:30 PM You must be able to provide your own transportation to the designated site for the day You are expected to arrive at the designated site 15 minutes early in order to be prepared to begin work at 8:00 AM You will be expected to adhere to our dress code. Thank you once again for your interest! CDH Painting, Inc. APPLICATION FOR EMPLOYMENT We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the organization. Personal Information Name (First Name, MiddlDates Employed: From to Reason for Leaving: Previous Employer: Complete Address: Telephone #: May We Contact Your Employer: oYes oNo Immediate supervisor and title: Your Position Title: Salary: Dates Employed: From to Reason for Leaving: Previous Employer: Complete Address: Telephone #: May We Contact Your Employer: oYes oNo Immediate supervisor and title: Your Position Title: Salary: Dates Employed: From to Reason for Leaving: Educational History (list school name and location, course of study, and any degrees) High School Years Completed College Years Completed Technical Training Years Completed References (List the names of 3 persons who have know you at least 1 year. Do not include relatives or employers.) Releases and Applicant s Signature In connection with my application for employment and as a condition of continuing employment, I understand that investigative background inquiries may be made on me including previous employers, schools, references, consumer credit, criminal convictions, motor vehicle, and other reports. These reports will include information as to my character, work habits, performance, education, compensation, and experience along with reasons for termination of employment from previous employers. Furthermore, I understand that the company may be requesting information from various federal, state, and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil, and other experiences as well as claims involving me in the files of insurance companies. I authorize without reservation, any party or agency contacted to furnish the above mentioned information and release all parties involved from liability and responsibility for doing so. I hereby consent to obtaining the above information from CDH Painting, Inc. and/or any of their agents. This authorization and consent shall be valid in original, fax or copy form. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities ACT (ADA) and other relevant federal and state laws. All applications will be kept on file for ninety (90) days. Initials I understand this application is not an employment contract, nor can it be used to create one. All hiring and employment at CDH Painting, Inc. is at will. Employment at CDH Painting, Inc. has no specific term and may be terminated by the employee or CDH Painting, Inc. at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law. I acknowledge that CDH Painting, Inc. has not made any promises or representations that differ from those contained in this paragraph. Initials I understand that the submission of any false information in connection with my application for employment, whether verbally or in writing, may be cause for withdrawal of any offer of employment or immediate discharge at any time thereafter should I be employed by CDH Painting, Inc. Any misrepresentation, when discovered, will result in termination. Initials I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment. Initials I release and agree to hold harmless any individual, company, business institution, or government agency from all liability for any damage that may result with regard to furnishing information to CDH Painting, Inc. I agree to release and hold harmless CDH Painting, Inc. from all liability for any damage that may result with respect to the receipt of such information. Initials I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions. Applicant s Signature Date www.Pre-employ.com Applicant Notification / Release of Information The purpose of this form is to notify you that a Consumer Report will be conducted on you in the course of consideration for employment or promotion. This report may include information relating to your character, general reputation, personal characteristics, or mode of living, and is being provided by Pre-employ.com, Inc.  P O Box 491570 Redding, CA 96049  Phone 530-378-7680. I hereby authorize your company or any agent of your company to contact any and all corporations, former employers, educational institutions, law enforcement agencies, city, state, county, and federal courts and military services to release information about my background including, but not limited to, information about my employment, education, driving record, criminal record, and general public records history to the person or company with which this form has been filed. This releases the aforesaid parties from any liability and responsibility for collecting the above information. I understand I have the right to obtain a free copy of this consumer report if; (1) Any adverse action/decision is made based on the information in the consumer report, & (2) If the request is made in writing within 60 days of the adverse action. I believe to the best of my knowledge that all information I have provided is accurate, true, and correct and that I fully understand the terms of this release. Please write clearly in Black Ink only Name: (Last) (First) (Middle) List any other name used in the last 7 years: Date of Birth ______ / ______ / ______ Social Security Number ________ - ______ - ________ Driver s License # State _______ Daytime Phone # Professional License Held State ______ Lic # List your current mailing address: Street or P.O. # City State Zip Your Signature: Today s Date: ____/ ____/ ____ California residents initial here if you wish a free copy of the report mailed to the address you supplied above. _______ (initials) ***APPLICANT  DO NOT WRITE BELOW THIS LINE*** FAX TO: (888) 999-3839 TO BE FILLED OUT BY COMPANY REQUESTING INFORMATION Company Name: _____CDH PAINTING, INC.___ PO/Location # ___95503__ _____ Please start our standard background check (ignore boxes below) Or, select from the following: ___ Criminal History ___ Civil History ___ Social Security Verification ___ Driving Report ___ Education/Degree Verification ___ Reference Check ___ National Wants & Warrants ___ Previous Employer Verification ___ Professional License Verification ___ O.I.G. Name Search ___ Urine Based Drug Test ___ Saliva Based Drug Test While the information contained in the reports provided has been obtained from public records data sources deemed reliable, its accuracy cannot be guaranteed due to potential error in the actual recording of the record. Since this information is not owned by Pre-employ.com, Inc., and since public records data on any one individual, group of individuals, company, or companies can be contained in more than one repository Pre-employ.com, Inc. can only rely on its accuracy from the public records data sources presently available at the time of the search. This information is furnished for your exclusive use and accepted by you without any liability on the part of Pre-employ.com, Inc. its sources, officers, agents or employees. Furthermore you agree to indemnify Pre-employ.com, Inc., its sources, agents, and employees of any liability for the use of this information and shall agree that the right to obtain and the purpose for this information, for your exclusive use, is fully within the appropriate law or laws which apply to the permissible purpose of retrieving background information on an individual s criminal records history and/or workers compensation claim history. 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