Employment Application

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Fidelity Contracting LLC is committed to provide our employees with a safe and stable work environment that promotes growth in knowledge and experience with fair compensation and benefits. Benefits include: health insurance, dental plan, vision plan, paid vacation, paid holiday, and 401K plan.

Fidelity Contracting is an Equal Employment Opportunity Employer.

This application is valid for 30 days. Application not valid unless complete.

Fidelity Employment Application Form

Contact Information

First Name

Middle Initial

Last Name

Street Address

City

State

Zip Code

Current Telephone Number

Email Address

Have you lived at this address for 3 years or more?

Yes

Previous Address

Did you live at this previous address for 3 or more years?

Yes

List other name(s) under which you attended school or were employed.

How did you learn about us?

Employment Agency

Friend

Relative

Walk-In

Other...

What Position are you applying for?

Applicant History

Do you have a resume?

Choose File

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Yes

Have you ever filed an application with us before?

Yes

Please give date

Are you currently employed?

Yes

May we contact your present employer?

Yes

Are you currently on "lay-off" status and subject to recall?

Yes

Have you ever been convicted of, or pled guilty or no contest to a misdemeanor or a felony such as fraud, embezzlement or misappropriation of funds, or false use of financial instruments, or of any other crime involving honesty?

Yes

Please give date, place, charge, and disposition.

Do you have any limitations regarding hours that you can work?

Yes

Please explain.

Do you have any travel restrictions?

Yes

Please explain.

Do you have transportation to the office and to job sites within a 1 hour radius of the office?

Yes

Do you have any friends or relative employed by this company?

Yes

Please list names.

When are you available for work?

Health Certifications

Do you have a current First Aid certification?

Yes

Give expiration date and certification agency.

Do you have a current CPR certification?

Yes

Give expiration date and certification agency.

Do you have a current OSHA 10 Hour Construction Safety certification?

Yes

US Military Service

Were you ever part of the US Military?

Yes

Military Service Details

Branch of Service

Length of Service

Rank/Rate at discharge

Are you a member of the Armed Services Reserve?

Yes

Capability

If this is your first contact with this company, you may skip this section.

Are you fully able, with or without reasonable accommodation, to perform the essential functions of the job for which you applied?

Yes

Describe how you would perform the job with or without a reasonable accomodation

Drivers License Information

Do you have a current drivers license?

Yes

Drivers License Details

Expiration Date

State

Driver's License Number

List all moving motor violations (other than parking) for the last 3 years

Education

Name & Address of High School

Course of Study

Years Completed

Diploma/Degree/Grade Completed

Additional Education

College

Trade School

Apprenticeship

Military

Correspondence

Other

College

Name of College

Address of College

Course of Study

Years Completed

Trade School

Name of Trade School

Address of Trade School

Course of Study

Years Completed

Apprenticeship

Place of Apprenticeship

Address of Apprenticeship

Course of Study

Years Completed

Military

Name of School

Address of School

Course of Study

Years Completed

Correspondence

Name of School

Address of School

Course of Study

Years Completed

Other Education

Name of School

Address of School

Course of Study

Years Completed

Employment Experience

Name of Employer

Employer Address

Employer Phone Number

Date Started

Date Stopped

Starting Salary/Wage

Ending Salary/Wage

Starting Position

Position at time of leaving

Name & Title of Supervisor

Reason for leaving or looking for another job?

Brief description of your responsibilities

List professional, trade, business civic activities, and office held

Additional Employment

Employment 2

Employment 3

Employment 4

Employment 2

Name of Employer

Employer Address

Employer Phone Number

Date Started

Date Stopped

Starting Salary/Wage

Ending Salary/Wage

Starting Position

Position at time of leaving

Name & Title of Supervisor

Reason for leaving or looking for another job?

Brief description of your responsibilities

Employment 3

Name of Employer

Employer Address

Employer Phone Number

Date Started

Date Stopped

Starting Salary/Wage

Ending Salary/Wage

Starting Position

Position at time of leaving

Name & Title of Supervisor

Reason for leaving or looking for another job?

Brief description of your responsibilities

Employment 4

Name of Employer

Employer Address

Employer Phone Number

Date Started

Date Stopped

Starting Salary/Wage

Ending Salary/Wage

Starting Position

Position at time of leaving

Name & Title of Supervisor

Reason for leaving or looking for another job?

Brief description of your responsibilities

References

Do not list relatives or employers.

Reference 1

Reference Name

Reference Address

Reference Phone Number

Reference 2

Reference Name

Reference Address

Reference Phone Number

Additional References

Reference 3

Reference 4

Reference 3

Reference Name

Reference Address

Reference Phone Number

Reference 4

Reference Name

Reference Address

Reference Phone Number

Important Authorization and Understanding

1. Completeness and accuracy of information

I represent that all of the information now or hereafter given by me in support of my application for employment is true and complete. I understand, that if I am hired, any false or misleading information in support of my application may subject me to discharge at any time during the period of my employment.

2. Authorization for release of information and release from liability

I authorize you to verify any of the information given during the application process with appropriate individuals, companies, institutions, or agencies and I authorize them to release such information as you require, including my prior disciplinary employment record, without any obligation to give me written notice of disclosure. I hereby release you and them from any liability whatsovever as a result of such inquiries and disclosures. A photocopy or other electronic reproduction of this authorization/release is binding, and may be relied upon.

3. Employment at will

I understand that if I am employed, I will be an employee at will. This means that either the employer or the employee may terminate the employment relationship with or whitout cause at any time.

4. No written, oral, or implied contracts

I understand that any written Company documents, oral statements, or formal or informal policies are not to be construed as granting an express or implied employment contract and that I am not entitled to rely upon any such documents, statements or Company policies as stating employment terms. The employment relationship with the company may be modified only in writing, directed to me by the President of the Company.

5. Benefits may be altered

I understand that the Company at its option may change, delete, suspend, or discontinue any part or parts of its benefit prgram at any time without prior notice, both while persons are actively employed and while retired or otherwise seperated from employment with the Company.

6. I understand that a test for drug and alcohol misuse may be required as part of the interview process, and I hereby authorize the release of test results to the Company

I hereby consent to the performance of such medical examination and testing. I waive all claims arising out of these procedures against the Company and those performing the examination and tests. I understand and consent that as a condition of continued employment, I will submit to drug and alcohol testing in the future. I authorize the release of any such subsequent testing to the Company and waive all claims against it for those performing the examination and tests. I understand that I will be subject to immediate termination for failing to submit to examination or testing.

7. If an employment relationship is established, I agree to wear or use all protective clothing or devices as may be required by the Company and to comply with all safety policies and procedures

I acknowledge that I have read and understand the above statement in its entirety, and have had the opportunity to ask questions regarding any aspect of this application, and that I accept the above terms

Yes

Email me a copy of this application

Yes