Employment Application

Personal Information

Name

First Last

Email

Current Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Permanent Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone No.

Secondary Phone No.

Referred By

Employment Desired

Position

Desired Start Date

Salary Desired

Are you employed now?

Yes
No

If so, may we inquire of your present employer?

Yes
No

Have you ever applied to Bernuchaux Contractor Inc. before?

Yes
No

Where and When?

Education History

High School

Location of High School

Years attended this High School?

Did you graduate from this High School?

Yes
No

List or describe any relevant courses studied at this High School.

Trade School

Location of Trade School

Years attended this Trade School?

Did you graduate from this Trade School?

Yes
No

List or describe any relevant courses studied at this Trade School.

College

Location of College

Years attended this College?

Did you graduate from this College?

Yes
No

List or describe any relevant courses studied at this College.

General Information

Describe any subject(s) of special study or research work.

List and describe any special training you have received.

List and describe any special skills you possess related to your desired job position.

List any U.S. Military or Naval Service and rank.

Employment History

List your last four (4) employers, beginning with the most recent.

Employer Name

Address of Employer

Salary

Position

Reason for Leaving

Employer Name

Address of Employer

Salary

Position

Reason for Leaving

Employer Name

Address of Employer

Salary

Position

Reason for Leaving

Employer Name

Address of Employer

Salary

Position

Reason for Leaving

References

Give the names of three (3) persons not related to you, whom you have known at least one year.

Reference Name

First Last

Phone

How do you know this person?

How many years have you know this person?

Reference Name

First Last

Phone

How do you know this person?

How many years have you know this person?

Reference Name

First Last

Phone

How do you know this person?

How many years have you know this person?

Authorization

Upload your résumé.

Max. file size: 64 MB.

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give Bernuchaux Contractor Inc. any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of Bernuchaux Contractor Inc. has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing by an authorized company representative. 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. I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, Bernuchaux Contractor Inc. will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment." In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

By checking this box, I agree to the terms stated above.*

I agree.

Phone

This field is for validation purposes and should be left unchanged.