Tomís Installation Company, Inc.

An Equal Opportunity Employer

Application for Employment

Type or Print Application Information

 

Personal Information

Name:  (Last, First, Middle)

 

Social Security #

Date of Birth

Street & Mailing Address

 

Phone (Include Area Code):

Alt. Phone

Are  you a US Citizen?  

 

[    ]  Yes          [    ]  No       List Nationality:

Driverís License #

 

State & Date of Issue

 

Marital Status

 

[    }  Married     [    ]  Single     [    ]  Divorced

No of Dependents:

E-mail:

 

Education & Training

High School

 

Date of Graduation:

Course of Study:

Vocational/Trade School:

 

Date of Completion:

Course of Study:

College

Number of Quarters/Credits:

Course of Study:

 

Other Training:

 

Date of Completion:

Course of Study:

         

Military Service

Branch of Service 

 

Dates of Service

Type of Discharge

Special Training:

 

Have you ever applied for a US Security Clearance?

[    }  Yes     [    ]  No

Was it granted?

 

[    ]  Yes    [    ]  No

Check Level:

[    ]  Top  Secret     [    ]  Other

[    ]  Confidential    [    ]  Secret

List Special Recognitions:

 

Employment History - Begin with most recent Employer

Name of Employer

 

 

Hire Date:

Term Date:

Position or Title

Starting Pay:

Ending:

[   ]  Hrly

[   ]  Salary

Address of Employer: 

 

 

Reason for Termination:

Name of Supervisor

Phone (Include Area Code)

Contact Employer?

Name of Employer

 

 

Hire Date:

Term Date:

Position or Title

Starting Pay:

Ending:

[   ]  Hrly

[   ]  Salary

Address of Employer: 

 

 

Reason for Termination:

Name of Supervisor

Phone (Include Area Code)

Contact Employer?

Name of Employer

 

 

Hire Date:

Term Date:

Position or Title

Starting Pay:

Ending:

[   ]  Hrly

[   ]  Salary

Address of Employer: 

 

 

Reason for Termination:

Name of Supervisor

Phone (Include Area Code)

Contact Employer?

 

 

List at Least Two Personal References

Name:

 

 

Address:

Phone (Include Area Code):

 

Employer:

Name:

 

 

Address:

Phone (Include Area Code):

 

Employer:

 

Please Read Before Signing

Have you been convicted of a felony?  [    ] Yes     [    ] No   (If yes, provide details on the reverse side of this application including dates.)

 

Tomís Installation Company, Inc. is an Equal Opportunity Employer and is interested and concerned for the safety and welfare of their employees and customers.  By signing this application you acknowledge that you, as an applicant, may be asked to submit to a drug/alcohol urine test as a condition of employment.  All results of such tests shall remain confidential, but shall be released to and become the property of Tomís Installation Company, Inc.   I certify that the information provided by me in this application is true and correct.

 

______________________________________________________                ___________________________

Cursive Signature of Applicant                                                                                                                Date

 (If you are unable to sign, insert your legal mark with a witness)

 

Distribution: One copy to Employee, one copy to Supervisor and original to Personnel File.

CONSENT FOR DRUG/ALCOHOL TESTING

 

 

 

If you are offered and accept employment with Tomís Installation Company, Inc., in the interest of safety for all concerned, you may be required to take a urine test for drug and/or alcohol use.

 

I, ___________________________________, have been fully informed of the reason for this urine test for drug and/or alcohol (I understand what I am being tested for), the procedure involved, and do hereby freely give my consent. In addition, I understand that the results of this test will be forwarded to my potential employer and become part of my record.

 

If this test is positive, and for this reason I am not hired, I understand that I will be given the opportunity to explain the results of this test.

 

I hereby authorize these test results to be released to Tomís Installation Company, Inc.

 

 

 

_______________________________________ Date: ______________

 Signature:

 

______________________________________ Date: ______________

 Witness: