Employment Application - Right Temp Mechanical

APPLICANT INFORMATION

FIRST NAME *

EMAIL ADDRESS *

LAST NAME

PHONE NUMBER

STREET ADDRESS *

CITY *

STATE *

ZIP CODE *

DATE AVAILABLE

DESIRED SALARY *

ARE YOU A CITIZEN OF THE UNITED STATES *

YES

IF NO, ARE YOU AUTHORIZED TO WORK IN THE U.S.

YES

HAVE YOU EVER WORKED FOR THIS COMPANY? *

YES

IF YES, WHEN?

HAVE YOU EVER BEEN CONVICTED OF A FELONY? *

YES

IF YES, PLEASE EXPLAIN

EDUCATION

NAME OF HIGH SCHOOL *

ADDRESS OF HIGH SCHOOL *

DID YOU GRADUATE? *

YES

FROM

DIPLOMA

NAME OF COLLEGE

ADDRESS OF COLLEGE

DID YOU GRADUATE?

YES

FROM

DIPLOMA

OTHER

ADDRESS

DID YOU GRADUATE?

YES

FROM

DIPLOMA

PROFESSIONAL REFERENCES

PLEASE LIST 3 REFERENCES

REFERENCE 1: FULL NAME *

RELATIONSHIP *

COMPANY *

PHONE *

COMPANY ADDRESS *

REFERENCE 2: FULL NAME *

RELATIONSHIP *

COMPANY *

PHONE *

COMPANY ADDRESS *

REFERENCE 3: FULL NAME *

RELATIONSHIP *

COMPANY *

PHONE *

COMPANY ADDRESS *

PREVIOUS EMPLOYMENT

COMPANY *

PHONE *

COMPANY ADDRESS *

SUPERVISOR NAME *

JOB TITLE *

STARTING SALARY *

ENDING SALARY *

RESPONSIBILITES *

FROM *

TO *

REASON FOR LEAVING *

MAY WE CONTACT YOUR PREVIOUS SUPERVISOR FOR REFERENCE? *

YES

DISCLAIMER + SIGNATURE

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

SIGNATURE FULL NAME *

TODAYS DATE *

EQUAL OPPORTUNITY EMPLOYER

Northridge Construction, Inc. and Northridge Hospitality Management, LLC an Equal Opportunity Employer. As required by law, we must record certain information to be made a part of our Affirmative Action Program. Applicants for employment are also invited to participate in the Affirmative Action Program by reporting their status as disabled, disabled veteran, veteran of the Vietnam era or other minority. In extending this invitation you are also advised that: (a) workers (applicants) are under no obligation to respond, but may do so in the future if they choose; (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for the necessary information to include in our Affirmative Action Program. We are a company that values diversity. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment. Please complete the information requested below. Thank you for your cooperation.

GENERAL APPLICANT NAME *

DATE COMPLETED *

POSITION APPLIED FOR *

PLEASE CHECK ALL (4) THAT APPLY

RACE OR ETHNICITY IDENTITY

Hispanic or Latino

White (not Hispanic or Latino)

Black or African American (not Latino)

Native Hawaiian or Pacific Islander (not Hispanic or Latino)

Asian (not Hispanic or Latino)

American Indian or Alaskan Native (not Hispanic or Latino)

Two or More Races (not Hispanic or Latino)

OTHER

Individual with Disabilities

N/A

NOTIFICATION AND AUTHORIZATION TO RELEASE CRIMINAL INFORMATION FOR EMPLOYMENT PURPOSES

NOTIFICATION The position for which I am being considered requires me to consent to a criminal background check as a condition of employment. This check includes the following: Criminal history reference searches for felony and misdemeanor convictions at the county and federal levels of every jurisdiction where I currently reside or where I have resided during the past 7 years; and sex offender registry searches at the county and federal levels in every jurisdiction where I currently reside or where I have resided.

AUTHORIZATION I hereby authorize Right Temp Mechanical, Inc. to conduct the criminal background check described above. In connection with this, I also authorize the use of law enforcement agencies and/or private background check organizations to assist Right Temp Mechanical, Inc. m collecting this information. I also am aware that records of arrests on pending charges and/or convictions are not an absolute bar to employment. Such information will be used to determine whether the results of the background check reasonably bear on my trustworthiness or my ability to perform the duties of my position in a manner which is safe for Right Temp Mechanical, Inc. and its employees.

POSITION(S) APPLIED FOR *

FULL LEGAL NAME (for identification purposes):

FIRST NAME *

MIDDLE NAME *

LAST NAME *

OTHER NAMES YOU HAVE USED IN THE PAST SEVEN YEARS:

CURRENT ADDRESS *

PREVIOUS ADDRESS (most recent) *

ADDRESSES IN THE SEVEN YEARS PRIOR TO COMPLETING THIS FORM *

PHONE NUMBER *

ALTERNATE PHONE NUMBER *

GENDER *

Male

Female

DATE OF BIRTH *

SOCIAL SECURITY NUMBER *

DRIVER'S LICENSE NUMBER *

STATE OF DRIVER'S LICENSE *

Have you ever been convicted of a criminal *offense or have any pending criminal* charges against you? *This refers only to felonies and misdemeanors; you do not need to include non-criminal traffic violations or municipal ordinance violations. *

Yes

To the best of my knowledge, the information provided in this Notice and Authorization and any attachments thereto is true and complete. I understand that any falsification or omission of information may disqualify me for this position and/or may serve as grounds for the severance of my employment with Right Temp Mechanical, Inc. By signing below, I hereby provide my authorization to Right Temp Mechanical, Inc. to conduct a criminal background check and I acknowledge that I have been provided with a summary of my rights under the Fair Credit Reporting Act which is attached. In addition to those rights, I understand that I have a right to appeal an adverse employment decision made by Right Temp Mechanical, Inc. based on my background check information within three business days of receipt of such notice and that a determination on my appeal will be made in seven working clays from Right Temp Mechanical, Inc. 's receipt of such appeal.

TYPE LEGAL NAME FOR SIGNATURE *

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APPLICANT INFORMATION

EDUCATION

PROFESSIONAL REFERENCES

PREVIOUS EMPLOYMENT

DISCLAIMER + SIGNATURE

EQUAL OPPORTUNITY EMPLOYER

NOTIFICATION AND AUTHORIZATION TO RELEASE CRIMINAL INFORMATION FOR EMPLOYMENT PURPOSES

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