Employment Form Contact Information First Name: Last Name: Street Address: Street Address 2: City: State: Zip Code: Phone Number: Mobile Number: Email Address: How long have you lived at your current address: Eligibilty Are you over 18 years of age: Yes No Are you currently authorized to work in the United States:Proof of eligibility will be required if hired Yes No Have you ever applied to or worked for us: Yes No If yes, when: Have you ever been convicted of a crime which is substantially related to the functions or qualifications of the job for which you are applying:(A conviction record will not necessarily disqualify you from employment) Yes No If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed and type(s) of rehabilitation: Do you have a valid driver's license?(Proof required if hired): Yes No What is your means of transportation to work: Type of Auto Insurance:(Proof required if hired) Have you had any accidents during the past three years: Yes No If yes, how many: Have you had any moving violations during the past three years: Yes No If yes, how many: You will be required to submit a copy of your Driving Record if hired. Position Position applying for: Wage desired (be specific): When are you available to start work: Travel Accomodations: Hotel Only Personal Travel Trailer Other (Please Specify) Are you available for nationwide travel: Yes No If no, please explain: Education School Type High School School Name Years Completed 12345678910 Major & Degree LocationComplete Mailing Address School Type CollegeBus. or Trade SchoolProfessional School Name Years Completed 12345678910 Major & Degree LocationComplete Mailing Address School Type CollegeBus. or Trade SchoolProfessional School Name Years Completed 12345678910 Major & Degree LocationComplete Mailing Address School Type CollegeBus. or Trade SchoolProfessional School Name Years Completed 12345678910 Major & Degree LocationComplete Mailing Address References Please list two references other than relatives Name Company Position Phone Address Name Company Position Phone Address Work Experience Please list your work experience for the past seven years beginning with your most recent job held. If you were self-employed, give firm name. Include additional information in notes section at end of this application if necessary. Name of Employer: Complete Address: Phone Number: Name of last supervisor: Starting Date: Ending Date: Starting Amount: Ending Amount: Job title: Reason for leaving(Be Specific): List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.: Name of Employer: Complete Address: Phone Number: Name of last supervisor: Starting Date: Ending Date: Starting Amount: Ending Amount: Job title: Reason for leaving(Be Specific): List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.: Name of Employer: Complete Address: Phone Number: Name of last supervisor: Starting Date: Ending Date: Starting Amount: Ending Amount: Job title: Reason for leaving(Be Specific): List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.: Name of Employer: Complete Address: Phone Number: Name of last supervisor: Starting Date: Ending Date: Starting Amount: Ending Amount: Job title: Reason for leaving(Be Specific): List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.: May we contact your present employer: Yes No Other Experience Have you been in the Armed Forces: Yes No Are you now in the National Guard: Yes No Specialty: Date Entered: Discharge Date: 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. Misc Please check each of the items that you own: Digital Camera Cell Phone Laptop Basic Construction Tools Union Cards Willing to work with tools Software Fluent With: Agreements APPLICATION FORM WAIVER - PLEASE READ CAREFULLY Please check each box below to indicate that you have read and understand the accompanying statement. In exchange for the consideration of my job application by Terry Adams, 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 of Terry Adams, 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 Terry Adams, Inc. may end the employment relationship at any time, 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. I understand that, in connection with the routine processing of your employment application, the Company may request information as to my 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 six months 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. Terry Adams, Inc. is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with Terry Adams, Inc. depends solely on your qualifications. Thank you for completing this application form and for your interest in our business. Submit Application