Connecticut (CT) Home Remodeling and Access Remodeling

TJ Nelson Home Improvements: Employment Production Application

Today's Date:
Last Name:
First Name:
Middle Initial:
Social Security #:
Present Address:
City:
State:
Zip:
Phone #:
Cell/Pager #:
E-mail:	(E-mail)
Date of Birth:
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?:	Yes No
In Case of an Emergency Notify: Name:
Address:
Phone Number:
Do you smoke:	Yes No
Are you married:	Yes No
Do you have a criminal record?:	Yes No
If yes, why?:
Do you have any substance abuse problems:	Yes No

EMPLOYMENT DESIRED:
Position:
Date you can start:
Salary Desired:
Are you employed now?:	Yes No
If so, may we inquire of your present employer?:	Yes No
Every applied to this company before?:	Yes No
When:
Referred By:

EXPERIENCE:
How much experience do you have for this position:
Are you able to work by yourself?:
Do you prefer to work with a crew?
What transportation do you have?: Make of Vehicle
Year of Vehicle:
Is your vehicle reliable?:	Yes No
Driver's License #:
Have you ever had your license taken away?:	Yes No
What skills, activities, studies, research do you have that would be of added interest?:
Do you have back injuries?:	Yes No
If so what:
Have you ever filed for a Workers Comp. Claim?	Yes No
If so, for what?:
Are you ble to lift up to 50 lbs.?:	Yes No
Have you even been part of the U.S. MILITARY OR NAVAL SERVICE?:	Yes No
Rank:
Present membership in National Guard or Reserves:

EDUCATION:
High School:
No. of years attended:
Did you graduate?:	Yes No
Subjects Studied:
Business School or College:
No. of years attended:
Did you graduate?:	Yes No
Subjects Studied:

FORMER EMPLOYERS: List below the last three employers, starting with last one first
Dates:
Name & Address of Employer:
Salary:
Position:
Reason for Leaving:

Dates:
Name & Address of Employer:
Salary:
Position:
Reason for Leaving:

Dates:
Name & Address of Employer:
Salary:
Position:
Reason for Leaving:

Which of these jobs did you like the best?
What did you like most about this job?

REFERENCES: Give the names of three persons not related to you, whom you have know atleast one year.
Name:
Address:
Phone:
Years Known:

Name:
Address:
Phone:
Years Known:

Name:
Address:
Phone:
Years Known:

Please fill in any questions that may pertain to you or the position you are applying for.
What types of painting have you done?
Exterior:
Interior:
How do you feel about being a Laborer?:
Do you have a fear of heights?:	Yes No
How high have you worked outside?:
Have you ever built a scaffolding before?:	Yes No
When?:
What tools of your own do you have available?
Hand:
Power:
Do you have any drywall experience?:
How much?:
Do you have any experience with wallpaper?:	Yes No
What wallpaper related tools do you have?:
While laboring, do you have any aspects of the building trades that you won't do? (examples: Insulation, taping, working in crawl spaces, demolitiong, pouring concrete, scraping paint):
Do you have any experience with siding and/or vinyl windows?:	Yes No
Do you have any experience with roofing?:	Yes No
Do you have any experience with plumbing/heating?:	Yes No
Do you have any experience with sheet rock?:	Yes No
Do you have any experience with flooring (carpets, vinyl ceramic, linoleum)?:	Yes No
What is your long range career goals?

TERMS AND CONDITIONS:
I Certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my emoployment may be changed with or without cause, and with or without notice, at any time by the company. I understand that managerial company representatives, including the president, has the authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

Date:	Check that you agree with the above terms:

I, give T.J.N. Enterprises, Ltd. permission to perform any background check including, but not limited to, a criminal history.

Date:	Check that you agree with the above terms:

Security Code:	Type the characters you see in the picture below.

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