Online Employment Application

Giese Employment Application

Date of Application

First Name

Middle Name

Last Name

Home Street Address

City

State

Zip Code

Phone No. (including area code)

Social Security No.

Who referred you to Giese Companies?

Do you have the legal right to work in the U.S.?

Yes

Please state your age if under 18.

Is there anything that will prevent you from performing the essential functions of the position for which you are applying or being considered? If yes, please describe.

Do you have a valid driver's license?

Yes

For what position(s) or type of work are you applying? Please list all and/or describe.

Rate of pay expected: $____ per hour.

Were you previously employed by us?

Yes

If yes and if prior employment was under a different name, please specify:

If yes, when?

Position(s) held:

Do you have any other experiences, skills, or qualifications which you feel would especially fit you for work with our organization?

Employment History

[Please start with your present, or most recent, position.]

1 / NAME OF EMPLOYER

Address (City + State)

Phone (including area code)

May we call you at this number?

Yes

Date stopped

Present salary/wage

Present position

Name + title of supervisor

Reason for leaving

Date of last increase

May we contact your present employer prior to employment by the Giese Companies?

Yes

Brief description of your responsibilities:

2 / NAME OF EMPLOYER

Address (City + State)

Phone (including area code)

Date started

Starting salary/wage

Starting position

Date stopped

Final salary/wage

Final position

Name + title of supervisor

Reason for leaving

Brief description of your responsibilities:

3 / NAME OF EMPLOYER

Address (City + State)

Phone (including area code)

Date started

Starting salary/wage

Starting position

Date stopped

Final salary/wage

Final position

Name + title of supervisor

Reason for leaving

Brief description of your responsibilities:

Record of Education

Convictions

Have you ever been convicted in a court of law?

Yes

If yes, where?

If yes, when?

If yes, type of conviction:

Military Service Record

Were you in the U.S. Armed Forces?

Yes

If yes, what branch?

Dates of duty: From (Month-Day-Year) To (Month-Day-Year):

Rank at discharge

List duties in the service, including special training:

In Case of Emergency, Notify:

Address

Phone (including area code):

Certification + Authorization

[Please read and understand this statement before signing your application.]

The information I have provided in this Application for Employment is true, correct, and complete. False, incomplete, or misrepresented information of any kind will be sufficient cause for my application to be rejected or, if discovered after I am employed, cause for immediate termination of my employment.

I authorize the employer to contact and obtain information about me from previous employers, educational institutions, and the "References" I provided, and any other party necessary to verify the accuracy of information I disclosed in this application, a related employment resume, or a personal interview. To assist in the processing of my Application, I waive all rights and claims I may otherwise have against the employer or its representatives, for seeking and using information to evaluate my employment request and all other persons, corporations, or organizations who provide information for this purpose.

This application will expire in thirty(30) days. After that date, unless otherwise notified, I understand that my status as an applicant will end. I may re-apply for employment in the future by completing a new application.

This application is not an employment agreement. If I accept an offer of employment, I understand that I will be an employee at will and that I or the employer may terminate my employment at any time, with or without cause and without prior notice, unless required by law. I understand that no one, other than an executive officer of the employer, has authority to enter into any employment agreement with terms contrary to the foregoing and then only in writing signed by such officer.

I understand that employment is conditioned upon satisfactorily passing a physical examination and/or drug test. I agree to complete a physical examination and/or drug test by your company when requested to do so.

I understand that providing direct deposit authorization is a mandatory condition of my employment and I agree to provide the necessary information.

I authorize my employer to obtain records from various Federal, State, and other agencies pertaining to my driver's license and driving record when requested to do so.

I fully understand and accept all terms and conditions in the above statement.

Date

Signature