Job Application

Fields marked with an asterisk (*) must be filled out before submitting.

Application Information

Name *
Last Name *
Street Adress *
City *
State *
Zip *
Phone *
Email *
Social Security *
Are you legally eligible for employment in the United States? *	Yes No
Have you ever worked for this company? *	Yes No
Have you ever been convicted of a felony? *	Yes No
If yes, explain:
Position Applied for: *
Are you currently Employed? *	Yes No
If so, may we contact your present employer?	Yes No
Salary Desired

Education

High School
High School Address
Did you graduate?	Yes No
College(s):
Did you graduate?	Yes No
Degree
What language(s) can you read, write, speak?
Level of fluency

References

Name
Company
Relationship
Phone

Name
Company
Relationship
Phone

Name
Company
Relationship
Phone

Previous Employment

Company
Address
Job Title
Phone
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
Starting & Ending date
Reason for leaving
May we contact your previous supervisor for a reference?	Yes No

In Case Of Emergency Notification

Name
Address
Phone
Requirements *	ALL EMPLOYEES ARE REQUIRED TO FURNISH THEIR OWN HARD HAT, WORK BOOTS, SAFETY GLASSES, AND PROPER CLOTHING. NO SHORTS, TANK TOPS, OR TENNIS SHOES ARE ALLOWED ON JOB SITES. LONG PANTS WORK BOOTS, AND HARD HATS ARE REQUIRED ON ALL JOBS AT ALL TIMES. ALL SKILLED EMPLOYEES WILL BE RESPONSIBLE FOR SUPPLYING HAND AND POWER TOOLS OF THEIR TRADE. IF EMPLOYED BY BARSH COMPANY I WILL ABIDE BY ALL SAFETY RULES AND REQUIREMENTS OF THIS COMPANY. PRE-EMPLOYMENT DRUG TESTING IS PAID FOR BY BARSH COMPANY. IN THE EVENT MY EMPLOYMENT WITH BARSH COMPANY IS TERMINATED (VOLUNTARILY OR INVOLUNTARILY) WITHIN THE FIRST THIRTY (30) DAYS OF EMPLOYMENT, BY SIGNING BELOW, I CONSENT TO AND AUTHORIZE BARSH COMPANY TO DEDUCT THE COST FOR THE DRUG TESTING EXPENSES FROM MY PAYCHECK.

Disclaimer And Signature *	EMPLOYMENT AT BARSH COMPANY IS ON AN “AT WILL” BASIS AND IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OR METHOD OF PAYMENT OF WAGES OR SALARY, BE TERMINATED AT ANY TIME WITH OR WITHOUT CAUSE. OTHER THAN THE PRESIDENT OF BARSH COMPANY, NO SUPERVISOR, MANAGER, OR OTHER PERSON, IRRESPECTIVE OF TITLE OR POSITION, HAS THE AUTHORITY TO ALTER THE AT WILL STATUS OF YOUR EMPLOYMENT OR TO ENTER INTO ANY EMPLOYMENT CONTRACT FOR A DEFINITE PERIOD OF TIME WITH YOU. ANY AGREEMENT WITH YOU ALTERING YOUR AT WILL EMPLOYMENT STATUS MUST BE IN WRITING AND SIGNED BY THE PRESIDENT OF BARSH COMPANY. I CERTIFY THAT MY ANSWERS ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. I UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF FACTS CALLED FOR IS CAUSE FOR DENIAL OF CONSIDERATION OF EMPLOYMENT. IF THIS APPLICATION LEADS TO EMPLOYMENT, I UNDERSTAND THAT FALSE OR MISLEADING INFORMATION IN MY APPLICATION OR INTERVIEW MAY RESULT IN MY RELEASE.

	WE ARE AN EQUAL OPPORTUNITY EMPLOYER, DEDICATED TO A POLICY OF NONDISCRIMINATION IN EMPLOYMENT ON ANY BASIS INCLUDING RACE, COLOR, AGE, SEX, RELIGION, DISABILITY OR NATIONAL ORIGIN.