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APPLI CAT I ON FOR EM PLOYM ENT

(Pre-Employment Questionnaire) (An Equal Opportunity Employer)

PERSONAL INFORMATION
DATE

LAST
NAME CONTACT PHONE NO
LAST FIRST

PRESENT ADDRESS
STREET CITY STATE ZIP

PERMANENT ADDRESS
STREET CITY STATE ZIP

COUNTRY INTERNATIONAL PASSPORT NO:

DO YOU HAVE INTERNATIONAL PASSPORT
Yes ❑ No ❑

EMPLOYMENT DESIRED
SALARY
POSITION DESIRED

FIRST
IF EMPLOYED, HOW MUCH NOTICE DO YOU REQUIRED BEFORE LEAVING FOR A PLACEMENT WITH
WITH JEFFERSON CONSTRUCTION COMPANY?

IF EMPLOYED, DO YOU HAVE VALID UNITED STATE VALID WORKING VISA {H-1B visa}?

IF YOU DON’T HAVE VALID UNITED STATE WORKING VISA {H-1B visa}, CAN YOU BE ABLE TO PROCURE
YOUR USWORKING
UNITED WORKIN VISA IN YOUR COUNTRY OR YOU PREFER COMPANY TO REFER YOU TO UNITED STATE
PROCUREYOUR
REGISTERED USCONSULTANT
VISA W WHO WILL PROCURE YOUR VISA AND IT WILL BE READY WITHIN SEVEN
DAYS?

*NO OF
EDUCATION NAME AND LOCATION OF SCHOOL YEARS *DID YOU SUBJECTS STUDIED

MIDDLE
ATTENDED GRADUATE?

GRAMMAR SCHOOL

HIGH SCHOOL

COLLEGE
TRADE, BUSINESS OR
CORRESPONDENCE
SCHOOL

Skills and Qualifications - Summarize any special training, skills, licenses, certificates and/or characteristics of yourself that may qualify
you as being able to perform job-related functions for the position which you are applying

SPECIAL SKILLS

AND WITH OR WITHOUT NOTICE. AT EITHER MY OR THE COMPANY'S OPTION. DATE MONTH AND YEAR NAME AND ADDRESS OF EMPLOYER SALARY POSITION REASON FOR LEAVING FROM TO FROM TO FROM TO FROM TO WHICH OF THESE JOBS DlD YOU LIKE BEST? WHAT DlD YOU LIKE MOST ABOUT THIS JOB? REFERENCES: GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU. OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING. HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME. WITH OR WITHOUT CAUSE. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE. MY APPLICATION MAY BE REJECTED AND. IF I AM EMPLOYED. AND I UNDERSTAND THAT IF ANY FALSE INFORMATION. MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. AT ANY TIME BY THE COMPANY. AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED. YEARS NAME ADDRESS BUSINESS ACQUAINTED 1 2 3 NAME ADDRESS PHONE NO. DATE SIGNATURE OF APPLICANT . WHOM YOU HAVE KNOWN AT LEAST ONE YEAR. OR MISREPRESENTATIONS ARE DISCOVERED. OTHER THAN IT'S PRESIDENT. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED. AND WITH OR WITHOUT NOTICE. IN CONSIDERATION OF MY EMPLOYMENT. STARTING WITH LAST ONE FIRST).FORMER EMPLOYERS (LIST BELOW LAST THREE EMPLOYERS. "I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE. AT ANY TIME. WITH OR WITHOUT CAUSE. AND THEN ONLY WHEN IN WRONG AND SIGNED BY THE PRESIDENT. OMISSIONS. I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS.