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Application Form

CG Schmidt is an Equal Opportunity Employer - Thank you for your interest

Position

Name*

First Last

Address*

Street Address City State Zip

Daytime Phone Number*

Evening Phone Number

Email*

I can provide proof of a legal right to work in the USA*

Yes

If under 18 years of age, I can furnish a work permit*

Yes

I am willing to travel*

Yes

I am currently on a "lay off" status and subject to recall*

Yes

I was previously employed by CG Schmidt, Inc.*

Yes

If yes, please indicate in what capacity, when and to whom you reported:*

For position(s) requiring valid driver's license: I have a driver's licence:

Yes

If yes, please indicate:*

State & Driver's Licence Number

I have been convicted of a crime other than a minor traffic violation:*

Yes

If yes, please give date(s), offense(s), and charge(s)*

A conviction will not automatically bar you from employment. Each conviction will be considered with respect to time, circumstances, and relationship to job applied for.

I am related to a current CG Schmidt, Inc. employee*

Yes

If yes, please indicate below: Name(s), Relationship(s) & Department(s)*

How were you referred to us:

EMPLOYMENT DESIRED

Type of Work Desired

Skilled Trades

Office/Clerical/Administrative

Management/Engineer

Yard

Position(s) applying for:*

I am interested in:

Full Time

Part Time

Date you are able to start:*

MM slash DD slash YYYY

Salary Requirements:*

Rate of pay you expect per hour

EDUCATION

List your educational experience which you believe is relevant for the position you are applying for.

High School

or Elementary if you did not attend High School

Name and Location:*

Years Completed:*

Did You Graduate?*

Yes

Course of Study:*

Overall Grade Average:*

College

Name and Location:

Years Completed:

Did You Graduate?

Yes

Course of Study:

Overall Grade Average:

Other Education

Graduate work, trade school, other

Name and Location:

Years Completed:

Did You Graduate?

Yes

Course of Study:

Future Education

Do you plan on furthering your education?

Yes

If yes, when and what area?

List any additional achievements, activities, honors, organizations and offices held which you feel are pertinent to this application:

EMPLOYMENT EXPERIENCE

INCLUDE MILITARY EXPERIENCE

List part-time and full-time positions. List present or last positions first. Please answer all questions. Resumes are not substitutes, but may be attached.

Resume

Max. file size: 20 MB.

I am currently employed*

Yes

You may contact my present employer*

Yes

Employer 1

Company Name*

Name & Title of Immediate Supervisor:*

Company Address*

Street Address Address Line 2 City State ZIP Code

Starting Job Title:*

Ending Job Title:*

Job Duties:*

Dates of Employment*

MM/YYYY - MM/YYYY

Employment Status*

Full-Time

Part-Time

Starting Salary:*

Ending Salary:*

Reason for Leaving:*

Employer 2

Company Name

Name & Title of Immediate Supervisor:

Company Address

Street Address Address Line 2 City State ZIP Code

Starting Job Title:

Ending Job Title:

Job Duties:

Dates of Employment

MM/YYYY - MM/YYYY

Employment Status

Full-Time

Part-Time

Starting Salary:

Ending Salary:

Reason for Leaving:

Employer 3

Company Name

Name & Title of Immediate Supervisor:

Company Address

Street Address Address Line 2 City State ZIP Code

Starting Job Title:

Ending Job Title:

Job Duties:

Dates of Employment

MM/YYYY - MM/YYYY

Employment Status

Full-Time

Part-Time

Starting Salary:

Ending Salary:

Reason for Leaving:

Explain periods of unemployment in excess of three (3) months during the past 10 years:*

References

List 3 people - preferably past supervisors. Do not include relatives.

Reference 1

Name*

First Last

Occupation*

Years Known*

Phone Number*

Email*

Reference 2

Name*

First Last

Occupation*

Years Known*

Phone Number*

Email*

Reference 3

Name*

First Last

Occupation*

Years Known*

Phone Number*

Email*

RESUME & COVER LETTER

File

Max. file size: 20 MB.

KNOWLEDGE, SKILLS & ABILITIES

Skilled Trades / Yard Help

Finish Carpenter

Rough Carpenter

Form Carpenter

Fork Lift

Concrete Laborer

General Laborer

Skid Loader

Truck Driver

Other Education Training, Licenses or Special Skills:

CG SCHMIDT, INC. IS AN EQUAL OPPORTUNITY EMPLOYER

It is the policy of CG Schmidt, Inc. to employ qualified persons without discrimination against any employee or applicant for employment because of race, religion, color, sex, physical or mental disability, developmental disability, sexual orientation, national origin, age or status as a special disabled veteran or veteran of the Vietnam era, except where a bona fide occupational qualification exists under applicable regulation.

SUBSTANCE ABUSE TESTING & ASSISTANCE PROGRAM

Union employees will be tested in accordance with the terms of applicable testing policies. Non-union job applicants will be tested only after a conditional offer for employment is made, and present employees will be tested upon suspicion and after accidents causing personal injury or property damage. All employment offers are contingent upon the successful completion of our pre-employment drug screen program.

APPLICANT AUTHORIZATION

Please read thoroughly - then accept
All the information I have provided in support of this application for employment is true and correct to the best of my knowledge.I understand that:

The issuance of this application does not indicate there are any positions open and does not in any way obligate CG Schmidt, Inc.
Completed applications remain active for 60 days from the date I complete the form.
I will not be paid for the time spent while applying for this position, taking a drug test, or any other processing prior to the beginning of employment.
I agree to abide by all CG Schmidt, Inc. rules and regulations, which are in effect or may be established in the future if I am hired.
If I am hired, completing this application for employment form does not change the fact that my employment is for an indefinite period of time, terminable at will by either the employer or me.
All provisions are necessarily subject to change without notice.
I am authorizing all corporations, companies, former employers, educational institutions, law enforcement agencies, city, state, county and federal courts, military services, and/or persons to release the information they may have about me to CG Schmidt, Inc. or their agents, and I release all parties involved from any liability and responsibility for doing so.

Acceptance & Signature*

I agree to the above conditions and to CG Schmidt Privacy Policy

INVITATION TO IDENTIFY

We are subject to certain governmental record keeping and reporting requirement for the administration of civil rights laws and regulations. In order to comply with these laws, we are required to invite you to voluntarily self-identify your race, ethnicity, disability and veteran status. Submission of this information is voluntary, and refusal to provide it will not subject you to adverse treatment. The information obtained will be kept confidential, will be maintained separate from your application or personnel file, and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government. When reported, data will not identify any specific individual.

Name

First Middle Last

Are you Hispanic or Latino?*

Yes

*A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish Culture or origin regardless of race.

Gender:

Male

Female

Other

If your answer above is "no", please identify your race

White: A person having origins in any of the original people of Europe, the Middle East, or North Africa

Asian: A person having origins in any of the original people of the Far East, Southeast Asia, or the Indian subcontinent, including, for example: Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, Philippine Islands, Thailand and Vietnam

American Indian or Alaskan Native: A person having origins in any of the original people of North and South America (including Central America), and who maintain tribal affiliation or community attachment

Black or African American: A personal having origins in any of the black racial groups of Africa

Native Hawaiian or Pacific Islander: A person having origins in any of the people of Hawaii, Guam, Samoa, or other Pacific Islands

Two or more races: All persons who identify with more than one of the above five races

Vietnam Era Veterans, other Eligible Veterans, Special Disabled Veterans and Individuals with Disabilities

Government contractors/subcontractors subject to the Vietnam Era Veterans Readjustment Act of 1974 and the Rehabilitation Act of 1973 are required to take affirmative action to employ and advance in employment Vietnam Era and other eligible Veterans, qualified special disabled veterans, and qualified disabled individuals.

Veteran of the Vietnam Era

A person who served on active duty for more than 180 days, any part of which occurred between August 5, 1964 and May 7, 1975, and was discharged with other than a dishonorable discharge. Veterans meeting the above criteria who served in the Republic of Vietnam between February 1961 and May 7, 1975 are also protected.

Yes

Other Eligible Veteran

A veteran who has served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized.

Yes

Special Disabled Veteran

A person entitled to compensation under laws administered by the Department of Veterans Affairs for a disability rated at 30% or more, or rated 10 or 20% in the case of a veteran was has been determined by the Department of Veterans Affairs to have a serious employment handicap, or a person whose discharge or release from Active duty was for a service-connected disability.

Yes

How Were You Referred to this Job?

School/College

Employee Referral

State Job Service

Employment Agency

Temporary Agency

Government Agency

Walk-In

Recruiters

Other

Disabled Individual

An individual who has a mental or physical impairment which substantially limits one or more major life activities, has a record of such impairment, or who is perceived as having such impairment.

Yes