Employment Application - Triptych Construction, LLC

APPLICANT INFORMATION

Name

First Middle Last

Date

Address

Street Address Address Line 2 City State ZIP Code

Phone

Email

Date Available

Social Security No.

Desired Salary

Date of Birth

Position Applied For

Are you a citizen of the United States?

Yes

No

If no, are you authorized to work in the U.S.?

Yes

No

Have you ever worked for this company?

Yes

No

If so, when?

Have you ever been convicted of a felony?

Yes

No

If yes, explain

EDUCATION

High School

Address

Street Address Address Line 2 City State ZIP Code

From/To

Did you graduate?

Yes

No

Degree

College

Address

Street Address Address Line 2 City State ZIP Code

From/To

Did you graduate?

Yes

No

Degree

Other

Address

Street Address Address Line 2 City State ZIP Code

From/To

Did you graduate?

Yes

No

Degree

REFERENCES

Please list three professional references.

Name

First Last

Relationship

Company

Phone

Address

Street Address Address Line 2 City State ZIP Code

Name

First Last

Relationship

Company

Phone

Address

Street Address Address Line 2 City State ZIP Code

Name

First Last

Relationship

Company

Phone

Address

Street Address Address Line 2 City State ZIP Code

PREVIOUS EMPLOYMENT

Company

Phone

Address

Street Address Address Line 2 City State ZIP Code

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

From/To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

Company

Phone

Address

Street Address Address Line 2 City State ZIP Code

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

From/To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

Company

Phone

Address

Street Address Address Line 2 City State ZIP Code

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

From/To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

MILITARY SERVICE

Branch

From/To

Rank at Discharge

Type of Discharge

If other than honorable, explain

DISCLAIMER AND 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. I understand that any job offer is contingent upon successfully passing a pre-employment drug test.

Date

Signature

Attach Resume

Max. file size: 100 MB.

AUTHORIZATION FORM

I authorize TRIPTYCH Construction LLC to inquire into my educational, professional and past employment history references as needed to research my qualifications for this position. I hereby give my consent to any former employer to provide employment related information about me to TRIPTYCH Construction LLC and will hold TRIPTYCH Construction LLC and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information. I authorize TRIPTYCH Construction LLC to obtain any credit and consumer check.

I understand that nothing in this employment application, the granting of an interview or my subsequent employment with TRIPTYCH Construction LLC is intended to create an employment contract between myself and TRIPTYCH Construction LLC under which my employment could be terminated only for cause. On the contrary I understand and agree that, if hired my employment will be terminable at will and may be terminated by me or TRIPTYCH Construction LLC at any time and for any reason. I understand that no person has any authority to enter into any agreement contrary to the foregoing

If employed, I will be required to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for completion of the Form I-9.

I hereby acknowledge that I have read and agree to the above statements.

Date

Signature