Employment Application

Personal Information

Name*

First Middle Last

Drivers License Number*

Drivers License State*

State

Permanent Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone*

Email*

Date of Birth*

Social Security #*

Do you have the legal right to live and work in the U.S.?*

Yes
No

Other name(s) under which you have been previously employed

Names of friends or relatives employed in this organization

Have you ever applied to this organization before?*

Yes
No

If Yes, give date and position applied for

Have you ever been employed by this organization before?*

Yes
No

If yes, list dates of employment

Do you have any family, business, health, or social restrictions or obligations that would prevent you from performing the job responsibilities?*

Yes
No

Do you have any physical or mental condition or handicap which would endanger the health or safety of yourself and or others or that may affect your ability to perform the job(s) for which you are applying?*

Yes
No

If yes, please describe such condition or handicap.

Have you ever been convicted of a felony?*

Yes
No

If yes, list dates, offenses, and disposition.

Convictions are not an automatic disqualification from employment.

Will you comply with the safety work and attendance policies of our organization?*

Yes
No

Employment Interests

Position(s) Desired or Area of Interest:*

CAD Technician
Data Technician
Survey Technician
Engineering Technician
Survey Party Chief
Unskilled Laborer
Skilled Laborer

Date Available*

Type of Employment You Are Seeking:*

Full Time
Part Time
Temporary

How will you get to work?*

How were you referred to our organization?*

Name of Referral Source:

Education/U.S. Military Service

Where did you attend high school & college? (Click the + button to add a new row)*

School Name & Address	Major	Years Completed	GPA	Degree/Diploma

Are you taking any educational course(s) presently?*

Yes
No
I will be soon

If Yes or you will be soon, what and where?

Have you ever served in the U.S. Armed Services?

Yes
No

US Military Duties and special training

Rank held at discharge

References

List 3-5 people we may contact who are qualified to evaluate your capabilities. Do not include relatives. (Click the + button to add a new row)

Name	Address	Occupation	Years Known

Employment History

Give employment record as completely as possible listing current or most recent employer first. Show unemployed or self-employed periods and indicate dates and comment on each period. Include part time or summer work.

Company Name (Most Recent)

Address

Street Address Address Line 2 City State ZIP Code

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Type of Business

Business Website

Base Rate of Pay (Hour/Week/Month)

Start	End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

Did you have another job before this one?*

Yes
No

Company Name (Second Most Recent)

Address

Street Address Address Line 2 City State ZIP Code

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Type of Business

Business Website

Base Rate of Pay (Hour/Week/Month)

Start	End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

Would you like to list another previous job?

Yes
No

Company Name (Third Most Recent)

Address

Street Address Address Line 2 City State ZIP Code

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Type of Business

Business Website

Base Rate of Pay (Hour/Week/Month)

Start	End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

Would you like to list a 4th job?

Yes
No

Company Name (Fourth Most Recent)

Address

Street Address Address Line 2 City State ZIP Code

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Type of Business

Business Website

Base Rate of Pay (Hour/Week/Month)

Start	End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

I agree to a Drug Screening at the company's expense.*

Yes
No

I agree to a Criminal Background Check at the company's expense.*

Yes
No

Acknowledgement

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that falsified or misleading statements on this application shall be grounds to deny my application or, if employed, to terminate my employment. I also understand that incomplete responses may result in the denial of my application or, if employed, the termination of my employment.

I understand that, as a condition of my consideration for employment with , or as a condition of my continued employment with Wilson & Associates Surveying & Engineering, P.C.(the Company), the Company may obtain a consumer report that includes, but is not limited to, my creditworthiness or similar characteristics, employment and education verifications, social security verification, criminal and civil history, personal interviews, DMV records, any other public records and any other information bearing on my credit standing, credit capacity, character, general reputation, personal characteristics and trustworthiness.

I hereby authorize and consent to the Company’s procurement of such a report. I understand that, pursuant to the federal Fair Credit Reporting Act, the Company will provide me with a copy of any such report if the information contained in such report is, in any way, to be used in making a decision regarding my fitness for employment with the Company. I further understand that such report will be made available to me prior to any such decision being made, along with the name and address of the reporting agency that produced the report.

I understand that this application is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract of employment. I further understand that if I am hired my employment will be AT WILL and that either party may terminate the employment relationship at any time, without prior notice and for any or no reason. I also understand and agree that no representative of the company has any authority to alter the at will relationship or 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 and signed by the President of Wilson & Associates Surveying & Engineering, P.C. and me.

Digital Signature:

Printing your First Name + Middle Initial + Last Name will act as your digital signature.

Date

Resume Upload (optional)

Accepted file types: doc, docx, pages, odt, rtf, tex, txt, wpd, wps, pdf, Max. file size: 128 MB.

If you have a resume you'd like to attach, please do so here. This is not required.

Would you like to add a cover letter?

Yes
No

Cover Letter (optional)

Max. file size: 128 MB.

Please upload your cover letter here. You may also copy and paste the contents of your cover letter in the space below.