Job Application

Applicant Prescreening

Please complete the following information for this questionnaire. Once completed, Connecting Elements, Inc will review information. This information will be maintained on file for a minimum period of 60 days. All qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or non-job related disabilities.

Date*

MM slash DD slash YYYY

DOB: mm/dd/yyyy*

MM slash DD slash YYYY

Name*

First Middle Last

Address

Street Address Address City State Zip

Phone*

Email*

1. Have you ever been convicted of a crime?*

Yes

If yes, explain (crime convicted):*

2. US Citizen?*

Yes

Authorized to work in the US?*

Yes

3. Do you have a valid SC driver’s license?*

Yes

Driving points against you? #

4. Driver’s license ever been suspended?

Yes

If yes, explain (Driver License):*

5. Indicate training and experience in the following and circle 1-5 with 1 being the lowest and 5 being the highest in using tools/equipment:

Cordless drill/screw gun:

Flat head screw driver:

Phillips head screw driver:

Hammer:

Mallet:

Magnetic torpedo level:

Pry bar:

Socket set:

Tape measure:

Channel locks

Plug in electrical tester:

Utility/box knife:

Hacksaw:

Adjustable wrench:

Read Blueprints:

Carpentry:

Signature*

Date Signature

MM slash DD slash YYYY

Thank you for taking the time to fill out the questionnaire. Please complete the next section below.

Release & Consent Form

All applicants MUST read & Sign

Drug/Alcohol Screening:

I, , hereby agree to submit to any and all blood test, urinalysis, or other alcohol/drug screenings/testing which Connecting Elements may require prior to, and as a conduction of, my employment or during my employment as a condition of continued employment. I release Connecting Elements and the person(s) or entity responsible for the testing from any claim that I have in the event my employment or prospective employment is adversely affected by the results of such test. I further acknowledge that my refusal to submit to any such test or a confirmed positive test shall be grounds for immediate termination or denial of employment.

Informational Background Screening:

In connection with my application for employment (including contract for services), I understand and it is agreed that the employer or his agent may investigation my background to ascertain any and all information of concern for my employment, whether same is of record or not. I understand that the reports may contain private or public information records on me including the following: Consumer Reports, Criminal Records, Driving (MVR) Records, Educational Information, Prior Employment Interviews & Verification, Personal Reference Interviews, Worker’s Compensation Records, any other information deemed pertinent to my position with Connecting Elements. These reports may include a variety of information including work ethics and information pertaining to my length of employment, salary history, and reason for dismissal; driving history; character; general reputation; driving history; criminal convictions; and mode of living. I understand that you will be requesting information from various Federal, State, and Local Agencies which may contain information on my past activities. I hereby authorize without reservations any party or agency contacted by this employer to furnish any or all information contained in your files.

Physical Examination:

I understand that as an applicant for a position with this company or in the tenure of my employment, I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job. I also understand and agree that, if a job is offered, the job may be conditioned on the results of the physical examination and pre-employment drug screening/testing.

Certification of Understanding:

I hereby certify and understand that I have the right to make a request of Connecting Elements or the provider of service, upon proper identification and the payment of any authorized fees, for the information in its files on me at the time of my request. Further, I authorize ongoing procurement of any of the above-mentioned reports, background screenings and/or drug and alcohol testing, at any time during my employment (or contract). I certify that all information in this application is true and complete to the best of my knowledge and that I have read and understand all of this employment application. I further agree and understand that misrepresentations or omissions of information or facts may result in my rejection or dismissal. If hired I agree to abide by all the rules and policies of the employer.

Identification Information:

All qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status or non-job related disability. The following information is needed for IDENTIFICATION PURPOSES ONLY.

Full Name

First

Date of Birth

MM slash DD slash YYYY

Race

Gender

Signature

Date

MM slash DD slash YYYY

This field is for validation purposes and should be left unchanged.