Job Application Form – Barnes Custom Enterprises



  Personal

First Name *

Middle Name

Last Name *

Address Number *

Street *

City *

State *

Zip Code *

Telephone Number(s) (Home)

Social Security Number

Position(s) Applied For *

Desired Hourly Wage

Date of Application *

If you are under 18 years of age, can you provide required proof of your eligibility to work?YesNo

Have you ever filed an application with us before?YesNo

If Yes, give date

Have you ever been employed with us before?YesNo

If Yes, give date

Are you currently employed?YesNo

May we contact your employer?YesNo

Do you own your own transportation?YesNo

If Yes, Is it dependable?YesNo

Year

Make

Model

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?YesNo

On what date would you be available to start work? *

Have you ever been convicted of a felony?YesNo

If Yes, please explain



  Education

Name and Address of School

Course of Study

Years Completed

Diploma Degree

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

In Spaces Provided, Indicate Any Languages, OTHER THAN ENGLISH, You Speak, Read Or Write

SpeakFluentGoodFair

ReadFluentGoodFair

WriteFluentGoodFair



  Physical Record

Do you have any physical condition which may limit your ability to perform the job?YesNo

If yes, please explain

Have you ever filed a Workers' Compensation Claim?YesNo

If Yes, please explain

Do you have any fear of heights?YesNo

If yes, what is your ladder/roof height limitation? Circle One10'20'30'



  Employment Experience

Employer

Dates Employed From

Dates Employed To

Address

Telephone Number(s)

Hourly Rate/Salary Starting

Hourly Rate/Salary Final

Job Title

Supervisor

Work Performed

Reason For Leaving

State Any Additional Information You Feel May Be Help Us Consider Your Application.

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Personal References

Name

Phone

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country