Position applying for:
Name:
Telephone:
Email:
Date of Birth:
Address:
To provide well fit Safety Gear we need:
If so, fill out the following:
Speak following languages:
I will be able to report to work _____ days after being notified I am hired.
How did you learn about this employment opportunity?
List most recent employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here, in the summary following this section or on an extra sheet of paper if necessary. No more than 10 years history recommended.
Employer name and address: Pay per hour: Position title/duties, skills: Supervisor: Telephone: Start, End date: Reason for leaving:
Employer name and address: Pay per hour: Position title/duties, skills: Supervisor: Telephone: Start, End date: Reason for leaving:
Employer name and address: Pay per hour: Position title/duties, skills: Supervisor: Telephone: Start, End date: Reason for leaving:
Employer name and address: Pay per hour: Position title/duties, skills: Supervisor: Telephone: Start, End date: Reason for leaving:
High school Name, Years completed, Field of study, Graduate or degree:
College or University Name, Years completed, Field of study, Graduate or degree:
Business or Technical Name, Years completed, Field of study, Graduate or degree:
Additional
Duty/specialized training:
Other qualifications such as special skills, abilities or honors that should be considered:
Types of computers, software, and other equipment you are qualified to operate or repair:
Professional licenses, certifications or registrations:
Additional skills, including supervision skills, other languages or information regarding the career/occupation you wish to bring to the employer’s attention:
List two personal references who are not relatives or former supervisors.
Name, Address, Telephone, Occupation, Years known:
Name, Address, Telephone, Occupation, Years known:
PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION
I certify that the information on this application and its supporting documents are accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents ground, for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize Tryzub Tower Services, LLC to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without obligation, to make a full response to any inquiries in connection with this application for employment. If requested, l agree to submit to a physical Exam, criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer for employment and that an offer of employment if tendered, does NOT constitute a contract for continued guaranteed employment. l understand that staff employees of Tryzub Tower Services serve at- will, and the employment relationship may be terminated at any time by either party or any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States and to comply with company and departmental regulations. I understand that working for Tryzub Tower Services, LLC is AT WILL employment, and either the employee or employer may terminate employment at any time for any reason. I understand that if employed on a temporary basis, I would be paid for hours worked only, and would be ineligible for benefits including paid time off. I understand that any benefits I receive may be subject to change or discontinuation at any time without prior notice. I understand that the first THREE MONTHS of regular employment represent a provisional period, during which I would not be eligible to apply for transfer or promotion and during which I may be terminated without right of appeal.
Date:
Submit Application