Address: 440 Hawkins Rd, Chatham, VA 24531
Phone: 434-432-8282; Fax: 434-432-2029
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Employment Application
THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT
but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law.
Haymes Brothers, Inc. is An Equal Opportunity Employer.
It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination.
Personal Information
First Name
Middle Name
Last Name
Home Phone
Cell Phone
Addresses
Mailing Address 1
Street
Street
City
City
State
State
Zip Code
Zip Code
Employment Information
Position Applied For
Date You Can Start (yyy-mm-dd)
Desired Salary $
Please answer all of the following questions.
1.
Have you ever been employed with this company before?
No
Yes
If yes, please provide dates:
2.
Have you ever applied with this company before?
No
Yes
If yes, please provide dates:
Employment History
Are you currently employed?
No
Yes
May we contact your present employer?
No
Yes
Most Recent Employer
Employer
Employer
City
City
State
State
Zip Code
Zip Code
Phone
Phone
Position Held
Position Held
From (m/yyyy)
From (m/yyyy)
To (m/yyyy)
To (m/yyyy)
Pay upon leaving
Pay upon leaving
Supervisor
Supervisor
Duties
Duties
Reason for Leaving
Reason for Leaving
Prior Employer 1
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State
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Position Held
From (m/yyyy)
To (m/yyyy)
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Supervisor
Duties
Reason for Leaving
Prior Employer 2
City
State
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Phone
Position Held
From (m/yyyy)
To (m/yyyy)
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Supervisor
Duties
Reason for Leaving
Prior Employer 3
City
State
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Phone
Position Held
From (m/yyyy)
To (m/yyyy)
Pay upon leaving
Supervisor
Duties
Reason for Leaving
Resume (Text Version)
Copy and Paste a text version of your resume here.
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Applicant Certification Agreement
1.
I authorize investigations of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. I understand that my employment is for no definite period and employment is “at will” and may be terminated at any time.
2.
I understand and agree, as a condition of employment, I will be required to pass a drug and/or alcohol examination. I understand that two valid identifications are required at the time of employment.
3.
I understand that by typing my name in the signature box below and submitting this application electronically, this becomes a legal and binding contract.
Security Code
Type Name in Signature Box:
Date:
2024-11-06 13:49:08
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