S.R. Weidema Application for Employment

We consider applicants for all positions without regard to race, color, creed, religion, national origin, sex, sexual orientation, disability, age, marital status, familial status, membership or activity in a local human rights commission, or status with regard to public assistance, or any other legally protected status. Equal Opportunity Employer “Drug Free Workplace”
How Did you Learn About Us?
Name
Address
Are you currently employed?
May we contact your present employer?
Are you currently on “lay-off” status and subject to recall?
Are you a member of a Union?
Have you ever filed an application with us before?
Have you ever been employed with us before?
Do any of your friends or relatives, other than your spouse, work here?
Can you travel if a job requires it?
Are you available to work?
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Proof of citizenship or immigration status will be required upon employment.

Education

High School Diploma
Undergraduate College Years Completed
Years Completed
Undergraduate College Diploma/Degree
Diploma/Degree
Graduate/ Professional Years Completed
Years Completed
Graduate/ Professional Diploma/Degree
Diploma/Degree

Work Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.
Employer Address
Please list Starting and Present Job Title
Please Describe Reason for Leaving
Supervisor
Employer Telephone Number(s)
Starting Date
Ending Date
Previous Employer 1 Contact
May We Contact?
Please Describe Work Performed
Employer Address
Please list Starting and Present Job Title
Please Describe Reason for Leaving
Supervisor
Telephone Number(s)
Starting Date
Ending Date
Previous Employer 2 Contact
May We Contact?
Please Describe Work Performed
Employer Address
Please list Starting and Present Job Title
Please Describe Reason for Leaving
Supervisor
Telephone Number(s)
Starting Date
Ending Date
Previous Employer 3 Contact
May We Contact?
Please Describe Work Performed
Employer Address
Please list Starting and Present Job Title
Please Describe Reason for Leaving
Supervisor
Telephone Number(s)
Starting Date
Ending Date
Previous Employer 4 Contact
May We Contact?
Please Describe Work Performed
Include explanation of any gaps in employment.
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status
Please Enter Years of Experience at the following Crafts:
Years
Years
Years
Years
Years
Years
Years
Years
Years
Years
Years
Years
Years
Years
Years
Years
Years
Years
Years
Have you worked with Trench Shields/Boxes?
Can you accurately set up lasers?
Can you read plans accurately?
Do you have the required license(s) for the position you are applying for?
Years of Experience
Years of Experience
Years of Experience
Type of Driver’s License and applicable Endorsements

Personal/Professional References

Do not include family members or past supervisors.
Name and Occupation
Telephone Number
Best Time to Call
Name and Occupation
Telephone Number
Best Time to Call
Name and Occupation
Telephone Number
Best Time to Call

Applicant's Statement

I certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also, that I am required to abide by all rules and regulations of the employer. Minorities and females are encouraged to apply. We use E-Verify to validate your ability to work legally in the United States. Equal Opportunity Employer – “Drug Free Workplace”
Clear Signature

S.R. Weidema – Voluntary Affirmative Action Form

Employees are treated during the hiring process and employment without regard to race, color, creed, religion, national origin, sex, sexual orientation, disability, age, marital status, familial status, membership or activity in a local human rights commission, or status with regard to public assistance. As an employer with an Affirmative Action Program, we comply with government regulations, including Affirmative Action responsibilities where they apply. The purpose for this Data Record is to comply with government record keeping, reporting and other legal requirements. Periodic reports are made to the government on the following information. The completion of this Data Record is optional. If you choose to volunteer the requested information please note that all Data Records are kept in a Confidential File and are not a part of your Application for Employment or personnel file. Please note: YOUR COOPERATION IS VOLUNTARY. Inclusion or exclusion of any data will not affect any employment decision.
Ethnic Origin
Gender
Are you a Vietnam-era veteran who served on active duty for more than 180 days during the Vietnam-era?
Are you a disabled veteran?
Please list Qualification and Dates
Do you have a disability or any physical condition which may limit your ability to perform the position for which you have applied?
Do you request that S.R. Weidema, Inc., consider any special arrangements to accommodate this condition?
If yes, please describe the job-related functional limitations that result from the impairment and any special accommodation or method or procedures, which would allow you to perform the duties of the position for which you are otherwise qualified.
Name
Date
Clear Signature