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APPLICATION
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Position Applied For
Date of Application
Full Name
Email:
Address
City
State
Postal/Zip Code
Phone Number
What is your desired salary range or hourly rate of pay?
Are you at least 18 years old?
Yes
No
Option 3
Are there any days, shifts, or hours you will not work?
Yes
No
If yes, please explain:
Are you available for out of town work?
Yes
No
If not, please explain
Can you, upon employment, submit documentation verifying that you are legally eligible to work in the U.S.?
Yes
No
Have you taken any illegal drugs in the last 30 days?
Yes
No
Do you smoke tobacco products, or use smokeless or "chewing" tobacco?
Yes
No
Have you ever applied or worked here before?
Yes
No
If yes, please provide dates:
When will you be able to start work?
How did you learn of our company?
Education: Describe any educational degrees, skills, training or experience you believe are relevant for the position:
Employment History: Company Name:
Company Address:
City
New Field:
Postal / Zip Code
Phone Number:
Dates Employed From:
S
Name of Supervisor:
Job Title and Job Duties:
Reason for Leaving:
Have you ever been discharged or forced to resign?
Yes
No
If yes, please explain:
Have you received any discipline in the last 18 months of employment?
Yes
No
If yes, please explain:
How many days absent did you have in the last 12 months of employment for reasons other than an on-the-job injury, a disability, military leave, jury duty, or religious holiday?
Have you signed nay non-compete agreements with any other employer that would restrict you from working with HGC? If yes, please explain:
Yes
No
If yes, please explain:
List any work related skills, training, or experience you believe are relevant to the position you are applying for; such as operating heavy equipment, computer skills, fluency in language(s), etc.:
Are you capable of lifting items weighing up to 75 pounds?
Yes
No
Are you capable of operating power tools/equipment safely?
Yes
No
Are you capable of working heights over 50 feet?
Yes
No
Are you capable of working heights over 100 feet?
Yers
No
Are you capable of working underneath structures in close spaces?
Yes
No
Are you capable of crawling from one area to another to gain access?
Yes
No
Are you capable of using standard construction hand tools?
Yes
No
Are you capable of using/wearing all required safety equipment?
Yes
No
Are you capable of walking through construction areas that may contain holes or narrow walkways?
Are you capable of working 10 hour days?
Yes
No
Do you have a valid drivers license?
Yes
No
License Number:
New Field:
Class:
Do you have any tickets?
Yes
No
If yes, please explain:
Has your license been suspended or revoked?
Yes
No
If yes, please explain:
Do you you have any DUI or DWI convictions?
Yes
No
New Field:
Do you have a reliable form of transportation to work?
Yes
No
If you have your own car, what is the Make, Model, Year, and Tag #?
Applicant Acknowledgement: I certify that the answers given herein are true and complete to the best of my knowledge. I understand that misrepresentations, omissions of facts or incomplete information requested in this application will remove me from further consideration for employment. In addition, if employed, any misrepresentations or omission of facts called for in this application will be cause for dismissal at any time without any previous notice.I understand that this application will only be considred "active" for 30 calendar days from the date of application.I authorize Herman Grant Company (herein called HGC) to contact my prior employers and authorize such prior employers to answer any or all questions regarding my prior employment. I herby indemnify HGC and my prior employer and hold them harmless from any claims arising from such authorization.I understand that, if employed, I agree to conform to the rules and regulations of Herman Grant Company (herein called HGC). I also agree that, just as I have, if hired, the right to resign my employment at any time for any reason at all, HGC reserves the right to terminate any employee at any time, for any reason, with or without cause. I understand that no representative of HGC, other than the President of HGC, has any authority to enter into any agreement contrary to the provisions contained int he employee handbook or any Addendum thereto unless the President of HGC makes such changes in writing to the employee personally.I hereby represent and warrant that I have read and fully understand the foregoing and see employment under these conditions of my own free will and in accordance with my own judgement.
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Signature
Date
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Our Location
1100 Ashmore Avenue
P.O. Box 15006
Chattanooga, TN 37415
Phone: 1-800-472-6826
Fax: 423-266-7227
Get in Touch
hermangrant@hermangrant.com
423-266-6138
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