Application For Employment Application For Employment An Equal Opportunity Employer - All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. PERSONAL INFORMATION Name * First Last * Last Address * Email * Phone * Date of Birth (mm/dd/yyyy) * Social Security # Are you eligible to work in the U.S? * Yes No Are you at least 18 years or older? (If no, you may be required to provide authorization to work.) * Yes No Can you work any shift? * Yes No Can you work overtime, including weekends? * Yes No Have you ever been terminated from employment or asked to resign by an employer? * Yes No If yes, please provide company names and details Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation? * Yes No EMERGENCY CONTACT Emergency Contact Name * Emergency Contact Phone * Alternate Phone EMPLOYMENT DESIRED Position desired * Date you can start * Desired rate of pay * Are you currently employed? * Yes No If so, may we inquire of your present employer? Yes No REFERRAL SOURCE How did you hear about us? * Have you ever worked for this company before? * Yes No Explain EDUCATION HIGH SCHOOL Name and location of school No. of yrs. Attended Degree Received Subjects studied/Major COLLEGE or UNIVERSITY Name and location of school No. of yrs. Attended Degree Received Subjects studied/Major EMPLOYMENT HISTORY Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration. Employer Name Phone Date worked (From-To) Address Job Title Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities Reason for leaving Employer Name Phone Date worked (From-To) Address Job Title Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities Reason for leaving Employer Name Phone Date worked (From-To) Address Job Title Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities Reason for leaving Employer Name Phone Date worked (From-To) Address Job Title Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities Reason for leaving Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain. * Computer Skills (please describe): * REFERENCES Give the names of three persons not related to you, whom you have know at least three (3) years. Name Name First First Last Last Contact Information Company Years Acquainted Name Name First First Last Last Contact Information Company Years Acquainted Name Name First First Last Last Contact Information Company Years Acquainted Please read carefully before submitting your application. Bamberg Board of Public Works (B.P.W) is an equal opportunity employer. B.P.W does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including secual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge of military service. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for BB.P.W to hire me. If I am hired, I understand that either B.P.W or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of B.P.W has the authority to make any assurance to the contrary. I attest with my submission of this application that I have given to B.P.W true and complete information on this application. No requested information has been concealed. I authorize B.P.W to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal. Submit If you are human, leave this field blank.
803.245.5128
info@bambergbpw.com
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