Employment Application "*" indicates required fields Step 1 of 7 14% Position Applied For*Scaffold ErectorWarehouse WorkerDriverOtherOther Position:* First Name* Last Name* Middle Name Street Address* City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code* Phone (Primary)*Phone (Alternate)Are you interested in:* Full Time Part Time Temporary Available Start Date* MM slash DD slash YYYY Desired Annual Salary/Wages* How did you hear about us? Newspaper Employment Agency Personal Inquiry Radio Friend/Relative Other Are you legally authorized to work in the United States?* Yes No If hired, can you provide proof of your eligibility to work in the United States?* Yes No Are you 18 years of age or older?* Yes No Have you ever been convicted of a felony?* Yes No A yes answer will not automatically disqualify you from employmentHave you ever applied for employment with AMERICAN SCAFFOLDING before?* Yes No If yes, please provide the date:* MM slash DD slash YYYY Has the company ever employed you before?* Yes No If yes, please provide the date:* MM slash DD slash YYYY Are you available to work overtime?* Yes No Do you have any friends or relatives working at AMERICAN SCAFFOLDING?* Yes No If yes, who?* (Driving Positions Only) Do you have a valid drivers license?* Yes No EducationHigh SchoolName and Location Years Completed1234Diploma/Degree*Yes, degree obtainedNo, degree not obtainedGEDCollegeName and Location Course of Study Years Completed1234+Diploma/Degree*No degree obtainedBachelor'sMaster'sGraduate School/OtherName and Location Course of Study Years Completed1234+Diploma/Degree*No degree obtainedGraduate degree obtainedMilitary ServiceWere you in the military?* Yes No If yes, what branch?* Rank at time of discharge* Have you had any job related training in the military? Yes No If yes, please describe* Employment History List your last three employers, starting with your most recent one first.Employer 1Name of Company Address Supervisor Title of Supervisor PhoneLast Position DutiesStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Starting Wage/Salary Ending Wage/Salary Other Compensation Reason for LeavingEmployer 2Name of Company Address Supervisor Title of Supervisor PhoneLast Position DutiesStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Starting Wage/Salary Ending Wage/Salary Other Compensation Reason for LeavingEmployer 3Name of Company Address Supervisor Title of Supervisor PhoneLast Position DutiesStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Starting Wage/Salary Ending Wage/Salary Other Compensation Reason for Leaving Personal/Professional References (Do not include family members or past supervisors)Reference 1Name PhoneBest Time to Call Occupation Reference 2Name PhoneBest Time to Call Occupation Reference 3Name PhoneBest Time to Call Occupation DetailsPlease provide an explanation for any gaps in your employment.Please list memberships in any job related organizations, clubs or professional societies. (Exclude organizations, the name or character of which indicate race, color, religion, sex, age, national origin, or any other protected characteristics as established by law.)Do you have other job related knowledge, skills and abilities that we should know about? If so, please describe below. I, the undersigned, understand that I am being considered as a potential employee of AMERICAN SCAFFOLDING and hereby certify that: 1. In consideration of my employment, I agree to conform to the policies and procedures of the Company. I understand that in accepting this application, AMERICAN SCAFFOLDING is in no way obligated to provide me with employment and that I am not obligated to accept employment if offered. 2. I understand that if I am hired, such hiring will not be for any definite period of time. Furthermore, I understand that if I am hired, I will be an employee at-will and I can be terminated at any time, with or without cause and with or without notice. 3. I understand that my status as an at-will employee, and the terns and conditions of that employment cannot be changed except in writing and signed by the President of AMERICAN SCAFFOLDING. 4. I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that any falsified statements on this application or omission of fact on either this application or during the pre-employment process will result in my application being rejected, or, if I am hired, in my employment being terminated. 5. I also understand that any offer of employment is conditioned on the completion of pre-employment tests and documentation. I will, upon request, sign all necessary consent forms. Signature (Name)* NameThis field is for validation purposes and should be left unchanged.