Employment Application - Worsham Brothers

General Information

Name

First

Middle

Last

Maiden Name

Please list maiden name if applicable.

Email

Present Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Social Security

Are you under age 18?

Yes
No

Can you provide proof of your eligibility to work?

Yes
No

Are you currently authorized to work in the United States?

Yes
No

Proof of eligibility will be required if hired.

Employment Desired

Full-Time Only
Part-Time Only
Full or Part Time

Wage Desired

When are you available to start work?

Education

High School

Name of School

Location

Number of Years Completed

College

Name of School

Location

Number of Years Completed

Major & Degree

Business or Trade School

Name of School

Location

Number of Years Completed

Major & Degree

Have you ever been convicted of a crime in the past ten years which is substantially related to the functions or qualifications of the job for which you are applying?

Yes
No

A conviction record will not necessarily disqualify you from employment.

Please explain the nature of offense(s) leading to conviction(s) and when.

Do you have a valid driver's license?

Yes
No

Driver's License Number

State of Issue

Expiration Date

Type of License

Operator
Commercial (CDL)
Chauffeur

What is your means of transportation to work?

References

Please list two references other than relatives.

Reference 1

First & Last Name

Relationship

Company

Position

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Reference 2

First & Last Name

Relationship

Company

Position

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Military

Have you ever been in the Armed Forces?

Yes
No

Are you a currently a member of the National Guard?

Yes
No

Specialty

Date Entered

Date Discharged

Work Experience

Please list your work experience for the past five years, beginning with your most recent position. If you were self-employed, give firm name.

Employer 1

Name of Employer

Name of Last Supervisor

Address

Address Line 1

Address Line 2

City

State

Zip Code

Employment Date

Please enter beginning and ending date of employment.

Pay or Salary

Please enter starting pay and final pay.

Reason for leaving

Please be specific.

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Please be specific.

May we contact your present employer?

Yes
No

Employer 2

Name of Employer

Name of Last Supervisor

Address

Address Line 1

Address Line 2

City

State

Zip Code

Employment Date

Please enter beginning and ending date of employment.

Pay or Salary

Please enter starting pay and final pay.

Reason for leaving

Please be specific.

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Please be specific.

Employer 3

Name of Employer

Name of Last Supervisor

Address

Address Line 1

Address Line 2

City

State

Zip Code

Employment Date

Please enter beginning and ending date of employment.

Pay or Salary

Please enter starting pay and final pay.

Reason for leaving

Please be specific.

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Please be specific.

Additional Work Experience

Please use this space to elaborate on any background, experience, or qualifications that you believe should be considered in evaluating your qualifications for employment. You may include hobbies, volunteer experience and any other activities you believe relevant. Please omit any information that would disclose your race, gender, age, marital status, ethnic origin, religious or political affiliations, or disability. Worsham Brothers, Inc. is an Equal Employment Opportunity Employer and we will take affirmative action to ensure the applicants and the employees are treated during employment, without regard to their race, color, religion, sex, or national origin.

State names of relatives or friends working for us:

After reviewing the attached job description, please indicate if you are able to perform the essential functions of the job for which you have applied?

Yes
No

Please identify those job functions that you cannot perform. If a reasonable accommodation is required to enable you to perform the job properly and safely, please describe:

Resume Upload

Click or drag a file to this area to upload.

Please use this section to upload your resume. Accepted file types: PDF, DOC, DOCX, JPG, PNG. One file is allowed, with a maximum file size of 5MB.

Application Form Waiver

PLEASE READ CAREFULLY.

AS AN INDICATION THAT YOU HAVE READ AND UNDERSTAND, PLEASE CLICK “I AGREE” BELOW.

In exchange for the consideration of my job application by Worsham Brothers, Inc. (hereinafter called “the Company”), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee Worsham Brothers, Inc., or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the Owner/Managing Member of the Company. Both the undersigned and Worsham Brothers, Inc. may end the employment relationship at any time, (AT-WILL; If Worsham Brothers, Inc. thinks you are not doing a good job, we think we no longer need you for the work that you perform, or if we want to replace you, we can terminate your employment without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, all previous employers (unless otherwise indicated), references and others and hereby release the Company from any liability as a result of such contact.

We use E-Verify to determine eligibility to work in the United States. I understand that I must complete a Form I-9 to prove my eligibility.

I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

I further understand that my employment with the Company shall be probationary for a period of ninety (90) days and further that at any time during the probationary period or thereafter, my employment relationship with the Company is terminable at will for any reason by either party.

Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, handicap or veteran status.

Waiver Agreement

I Agree