Application for Employment
Secure Connection
Equal Opportunity Employer
* indicates required entries

PERSONAL INFORMATION

First Name *

Middle Name

Last Name *

Street *

City *

State *

Zipcode *

Primary Phone Number *

Mobile Phone Number

Email Address

Social Security Number

Are you 18 years of age or older? *

Yes  No

Have you ever been convicted of any misdemeanor or felony (this includes, without limitation, pleading guilty, pleading no contest, or having a judicial finding of guilt)? *

Yes  No

  If yes, where, for what, and when

Type or Position applying for *

Salary or Rate of Pay Desired

Date Available? *

Were you previously employed by Queen City Awning? *

Yes  No

If yes, list dates of employment and position(s) held?

Have you previously applied here? *

Yes  No

If yes, when?

Any relatives working at Queen City Awning? *

Yes  No

If yes, list each employee’s name and relationship:

Do you have a reliable means of transportation to and from work? *

Yes  No

Do you have a valid driver’s license?

Yes  No

List below three persons you have known for at least one year (exclude former employers and relatives):

1. Name
Address
Phone Number
2. Name
Address
Phone Number
3. Name
Address
Phone Number

EDUCATIONAL BACKGROUND

High School
Course of Study
Graduate? yes
Degree
College
Course of Study
Graduate? yes
Degree
Graduate
Course of Study
Graduate? yes
Degree
Trade School
Course of Study
Graduate? yes
Degree
Other
Course of Study
Graduate? yes
Degree

WORK HISTORY (applications without a complete work history will not be considered)

1. Company Name
Phone #
Address
Job Title
From Date
To Date
Reason for Leaving
Salary/Rate
Supervisor’s Name
2. Company Name
Phone #
Address
Job Title
From Date
To Date
Reason for Leaving
Salary/Rate
Supervisor’s Name
3. Company Name
Phone #
Address
Job Title
From Date
To Date
Reason for Leaving
Salary/Rate
Supervisor’s Name
4. Company Name
Phone #
Address
Job Title
From Date
To Date
Reason for Leaving
Salary/Rate
Supervisor’s Name

Are you on layoff and subject to recall?

Yes  No

Are you known to schools, references or employers by another name?

Yes  No

If yes, please indicate the name(s)

List any special skills or training you feel we should be aware of in considering your application:

APPLICANT STATEMENT

Read the following agreement and indicate your approval

I hereby certify that all responses set forth during my employment application process are true and complete. I understand and agree that any falsification, misrepresentation, or omission either on the employment application form or in my responses to questions asked during the interviewing or examination process may disqualify me from further consideration for employment, or if employed by Queen City Awning will subject me to immediate termination whenever the falsification or omission is discovered. In this regard, where an item is left blank on the employment application, it is because there is no information within its scope.

My acceptance authorizes Queen City Awning or its authorized agents to conduct a thorough investigation of all statements, written or oral, made by me during the employment application process, including without limitation, information concerning my employment positions, law enforcements record, driving record and educational background. I hereby authorize all persons, companies or other entities connected with any such informational request, including without limitation, current or prior employers and law enforcements agencies to provide any and all information they may have regarding me or my employment. I release and agree to indemnify Queen City Awning, its authorized agents, and its employees, and all other persons, companies, and other entities from any and all liability arising out of such investigation, including without limitation, any liability for furnishing information or for taking any action based on the information provided.

I understand that a drug and/or alcohol screen may be required before and during my employment. In addition, I authorize a medical examination, including a drug and/or alcohol screen, by an examiner selected by Queen City Awning if I am made a contingent offer of employment. I release and agree to indemnify Queen City Awning, its authorized agents, and its employees, and all other persons, companies, and other entities from any and all liability arising out of any medical examination or drug/alcohol screen or for the taking of an action based on the results of any medical examination or drug/alcohol screen.

I agree and consent that Queen City Awning may inspect any Queen City Awning property at any time and for any reason without notice. This property includes, without limitation, workstations, computers, offices, desks, lockers, voice mail and filing cabinets. Additionally, I agree and consent that any personal items I bring onto Queen City Awning’s premises are subject to inspection at any time and for any reason, without prior notice.

I certify that I am a citizen of the United States, or if not, I can provide required documentation permitting me to work in the United States.

I understand and agree if I am employed by Queen City Awning, my employment is at-will so that I may terminate my employment at any time and for any or no reason. Likewise, Queen City Awning can terminate my employment at any time and for any or no reason. I also understand and agree that nothing contained in Queen City Awning’s employment application or in the granting or conducting of an interview or anything set forth in any oral or written statement, communication, or policy now or in the future constitutes or creates or is intended to constitute or to create a contract or promise between me and Queen City Awning for employment, hours of work, or for the providing of benefits. Moreover, I acknowledge that Queen City Awning may modify, revoke, suspend, terminate, or change any or all of its plans, polices, or procedures at any time, without prior notice. No promises or guarantees regarding employment, hours of work, or for the providing of benefit have been made to me. I further understand and agree that no such promise or guarantee is binding on Queen City Awning unless it is in writing signed by me and an officer of Queen City Awning, and the document states that the employment relationship is not “at-will” and derails the specific promise or guarantee.

READ CAREFULLY BEFORE AGREEING. In consideration of Queen City Awning’s review of my application, I knowingly agree and understand that any claim or lawsuit arising out of my application for employment with, my employment with, or subsequent separation from Queen City Awning must be filed no more then one hundred and eighty (180) calendar days after the date the employment action that is the subject of the claim or lawsuit. While I understand that the statue of limitations for claim or actions arising out of any employment action may be longer then one hundred and eighty (180) calendar days, I agree to be bound by the one hundred and eighty (180) calendar day period of limitations set forth herein, and I waive any STATUE OF LIMITATIONS TO THE CONTRARY.

Check the box below and enter your initials to indicate your acceptance.

I have read and understand the contents of this employment application and am fully able and competent to complete it.

Enter your initials

We respect your privacy. We will not trade, rent or sell your information.