Employment Application * Indicates required field Personal Details Name Social Security Number Position(s) applied for: Contact Info Address City State Zip Telephone Cell Phone Email Address How did you hear about us? Sellers Website Indeed.com Careerbuilder.com Other Job Board Word of Mouth Internet Search Trade Publication Driver's License Number State Class Driver's License number required if driving is required for the position for which you are applying Additional Info If you are under 18 and it is required, Can you furnish a work permit? Yes No If no, please. Have you ever been employed at Sellers Construction? Yes No If yes, detail dates and position. Are you legally eligible for employment in this country? Yes No Date available for work Desired salary range Have you ever pleaded "guilty" or "no contest" to, or been convicted of a crime? Yes No If yes to above, please explain. Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accomodation) Yes No Need more info about the job’s “essential functions” to respond Employment History (Last 5 years) Starting with your most recent employer, provide the following information 1 Employer Telephone Address City State Immediate Supervisor and Title (for most recent position held) May we contact for reference Yes No Later Starting job title/Final job title Dates Employed Starting Salary Final Salary Why did you leave? Summarize the type of work performed and job responsibilities. 2 Employer Telephone Address City State Immediate Supervisor and Title (for most recent position held) May we contact for reference Yes No Later Starting job title/Final job title Dates Employed Starting Salary Final Salary Why did you leave? Summarize the type of work performed and job responsibilities. 3 Employer Telephone Address City State Immediate Supervisor and Title (for most recent position held) May we contact for reference Yes No Later Starting job title/Final job title Dates Employed Starting Salary Final Salary Why did you leave? Summarize the type of work performed and job responsibilities. Education Background Level of Education High School Graduate Some High School GED Associates Degree Bachelors Degree Masters Degree Doctorate Schools Attended, Dates and Degrees * References with Phone Numbers and/or Email Addresses Reference 1 Reference 2 Reference 3 Summarize why You are a good fit at Sellers Skills, Qualifications, Certifications Employment Experience Computer Skills Upload Resume The Company is an Equal Opportunity/Affirmative Action employer, and as a federal contractor, we are required to take affirmative action to employ and advance females, minorities and protected veterans. To comply with these laws, we invite you to voluntarily self-identify your race/ethnicity, gender, and protected veteran status. Submission of this form is voluntary and will not, in any way, subject you to adverse treatment. Responses will be kept confidential and will not be used in a manner that is inconsistent with any law. Gender * Male Female Choose not to identify Ethnicity * White (Not Hispanic or Latino) Black (Not Hispanic or Latino) Hispanic or Latino Asian (Not Hispanic or Latino) American Indian/Alaska Native (Not Hispanic or Latino) Native Hawaiian/Pacific Islander (Not Hispanic or Latino) Two or more races (Not Hispanic or Latino) Choose not to identify “Disabled Veteran” is defined as a (1) veteran of the U.S. military, ground, naval, or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans Affairs; or (2) a person who was discharged or released from active duty because of a service-connected disability. “Active Duty Wartime or Campaign Badge Veteran” means any veteran who served on active duty in the U.S. military, ground, naval, or air service during a war or in a campaign or expedition for which a campaign badge has been authorized. “Armed Forces Service Medal Veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval, or air service, participated in a United States military operation for which an Armed Forces service medal was awarded. “Recently Separated Veteran” is defined as any veteran discharged or released from active duty in the past three years. If you belong to any of the categories of protected veterans listed above, please indicate by selecting the appropriate response below. Veteran Status * I identify as one or more the categories of protected veterans listed above I am not a protected veteran, or I choose not to disclose my protected veteran status Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. We are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary. Any answer you give will be kept private and will not be used against you in any way. You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disability Status * Yes, I have a disability or previously had a disability No, I do not have a disability I do not wish to answer Digital Signature I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. I expressly authorize without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this application remains current for only 90 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurance to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 in this regard. This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability or any other protected status under applicable federal, state, and local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status. The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer’s service, whenever it is discovered. DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement. Clicking this button is your DIGITAL SIGNATURE. * Submit
Employment
