ONLINE EMPLOYMENT APPLICATION

PART 1 OF 4

PERSONAL INFORMATION
First Name Middle Name Last Name
   
Home Street Address
 
City State ZIP
     
Home Phone Cell Phone Email
 
Social Security Number

 

EMPLOYMENT DESIRED
Position Desired Shift Desired
   
How Did You Learn Of This Position
Newspaper
 Billboard
TV
 Radio Ad		 Internet
 Other
Employee 
Who?
Have You Ever Been Employed With Bivins Homes? If So, When? If less than 18 Years of age, do you have a work permit?
Yes  No Yes  No
Are You Available To Work
WeekendsYes  No HolidaysYes  No Rotating ShiftsYes  No

 

EDUCATION/TRAINING
High School Courses Taken
 
Did You Graduate? Diploma, Degree or Certificate Received
 Yes No
College/Technical Courses Taken
Did You Graduate? Diploma, Degree or Certificate Received
Yes No  If yes, Date:
Graduate/Professional Courses Taken
Did You Graduate? Diploma, Degree or Certificate Received
Yes No  If yes, Date:
Other Class/Training  
Area of Specialization or Major Interest:
Professional organization membership, honors received, volunteer or community service or other qualifications you have which you feel are related to the position for which you are applying:
Have you ever been convicted of a crime?  (Conviction does not necessarily preclude your employment)
Yes  No
If so, when, where and for what? 

 

PROFESSIONAL LICENSE AND/OR CERTIFICATES
Type Organization/State Issued: Date Issued: Number:

 

MILITARY RECORD
Military Branch Entry Rank Separation Rank
Separation Date(s) Military Occupation Specialty
Specialized Training:
List Service Awards, Commendations:

 

EMPLOYMENT HISTORY
List current (or most recent) employer first and all others in reverse chronological order
Company Name Start Date End Date
     
Street Address, City, State, Zip
 
Position Title Company Phone Number Immediate Supervisors Name and Title
     
Job Description and Responsibilities:
 
Starting Salary Ending Salary Reason for Leaving
     
May we contact for reference?  Yes  No
Company Name Start Date End Date
Street Address, City, State, Zip
Position Title Company Phone Number Immediate Supervisors Name and Title
Job Description and Responsibilities:
Starting Salary Ending Salary Reason for Leaving
May we contact for reference? Yes  No
Company Name Start Date End Date
Street Address, City, State, Zip
Position Title Company Phone Number Immediate Supervisors Name and Title
Job Description and Responsibilities:
Starting Salary Ending Salary Reason for Leaving
May we contact for reference? Yes  No

 

PERSONAL REFERENCES
Name and Relationship Title Company Name & Address Phone
     
     
     

I understand that emergency conditions may require me to temporarily work shifts other than the one for which I am applying and agree to such scheduling change as directed by my superior of this institution.

Check this box to certify that you have read and accept the above statement.

If your availability status changes, it is your responsibility to notify your supervisor or the administrator. Such changes will be effective, then for any future employment.

I understand that this application will remain active for a maximum of 30 days.  If I have not been offered employment within these 30 days and wish to be considered further, it will be necessary for me to re-apply when Bivins Homes are accepting application.

Check this box to certify that you have read and accept the above statement.

This institution does not discriminate in hiring or any other decision on the basis of race, color, gender, citizenship, national origin, veteran status, or on the basis of age or physical or mental disability to perform the work required.  No questions on this application are intended to secure information to be used for such discrimination.

I voluntarily give this institution the right to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release all liability or responsibility all persons, companies or corporate supplying such information.  I consent to the complete health screen, including background screen and drug screen as may be required by this institution at such times and places, as the institution shall designate.  I understand that a continued offer of employment may be contingent on passing the health screen, including background screen and drug screen, which relates to the essential duties I would be required to perform.

I acknowledge that if hired, i will be an at will employee.  I will be subject to dismissal or discipline without notice or cause, at the discretion of the employer.  I understand that no representative of the company, other than the president, has authority to change the terms of an at will employment and hat any such change can occur only in a written employment contract.  I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form.

If employed, I will be required to complete an Employment Verification Form (I-0), and within three days show satisfactory evidence of identity and eligibility for employment.

Check this box to certify that you have read and accept the above statement.