Butt Construction Company




Personal Information
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Employment Desired
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Job History
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Previous Empoyer 1 (Start Date)
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Previous Employer 1 (End Date)
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Previous Employer 2 (Start Date)
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Previous Employer 2 (End Date)
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Graduate - High School
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Graduate - College
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Business References:
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Reference 1
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Reference 1 Phone
Reference 2
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Reference 2 Phone
Reference 3
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Reference 3 Phone
In Case of Emergency Notify:
“I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company’s rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time at either my or the company’s option. I understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than its President, and then only when in writing and signed by the President, has any authority to enter into any agreement for my employment for any specific period of time, or to make any agreement contrary to the foregoing.”
Authorization for Consumer Report
Authorization to Obtain Consumer Report Pursuant to 15 U.S.C. § 1681b(b)(2)(B) I authorize Butt Construction Company to obtain a consumer report for employment purposes. I understand that the inquiry may include, but is not limited to: conviction records, motor vehicle records, credit checks, references, and copies of prior personnel files.
Pre-Employment Testing Agreement
I, [NAME], understand that as a candidate for hiring by Butt Construction Company I may receive a conditional offer for employment based in part upon my consent and submission to a drug test. This drug test will be performed on a specimen of urine or blood which I give voluntarily; and that, for accuracy, if the initial test is positive the test will be confirmed through a second for comprehensive test (GC/MS). I understand that as a result of refusing to take the pre-employment drug test or if there is a positive result in any such test, I will not qualify for employment with Butt Construction Company and any employment offer extended or employment already begun will be withdrawn. I further understand that any employment offer extended to me is subject to Butt Construction Company’s final review and approval of my application and hiring even if I have a negative result on my pre-employment drug test. This testing policy also does not modify the employment-at-will status between Butt Construction Company and myself. I understand that to receive the results of my pre-employment drug test, I must submit a written and signed request to Butt Construction Company. The test results will then be made available to me within sixty days from Butt Construction Company’s receipt of the request. I also understand that to promote safety and health of its workforce and as a condition of employment, Butt Construction Company requires employees to comply with the Company Substance-Free Workplace Policy, which includes consenting to drug and alcohol testing. Further, that as an employee I may be subject to testing as it is required by the owner of any project in which Butt Construction Company serves as a contractor. My signature verifies that I have reviewed and understand the pre-employment drug testing policy of Butt Construction Company. Further, I agree to submit a pre-employment drug test and to allow the release of test results to Butt Construction Company.
Application Data Record
Applicants are considered for all positions and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or disability. As employers/government contractors, we comply with government regulations and affirmative action responsibilities. Solely to help us comply with government record keeping, reporting and other legal requirements, please fill out the applicant data record. We appreciate your cooperation. This data is for periodic government reporting and will be kept in a confidential file separate from the application for employment.
Referral Source
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Affirmative Action Survey
Government agencies require periodic reports on the sex, ethnicity, disabled and veteran status of applicants. This data is for analysis and affirmative action only. Submission of information about a disability is voluntary.
Affirmative Action: Sex
This Information is Voluntary. It will only be used for affirmative Action Analysis.
Affirmative Action: Race/Ethnicity
This Information is Voluntary. It will only be used for affirmative Action Analysis.
Affirmative Action: Disabled/Veteran
This Information is Voluntary. It will only be used for affirmative Action Analysis.