Work Application

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Commercial Builders Lic. #388218 (661) 948-7859 • 1120 W Avenue L-8 • Lancaster, CA 93534

Personal Information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Position & Wage Desired*

Date you can start*

Education

Grammar School Name & Location

Grammar School Grade Completed

High School Name & Location

High School Grade Completed

High School Graduate? Yes / No

College Name & Location

College Grade Completed

College Graduate? Yes / No

Yes
No

Trade or Business School Name & Location

Trade or Business Grade Completed

Trade or Business School Graduate? Yes / No

Yes
No

Former Employment

List below your last employers or mayor periods of unemployment (1 month or more)

Name, Address and Phone # of Employer and/or List Periods of Unemployment

Must include: Date range Salary on leaving Position Reason for leaving

Name, Address and Phone # of Employer and/or List Periods of Unemployment

Must include: Date range Salary on leaving Position Reason for leaving

Name, Address and Phone # of Employer and/or List Periods of Unemployment

Must include: Date range Salary on leaving Position Reason for leaving

References

List below three persons not related to you, whom you have known at least one year.

Reference 1

Include Name, Address, Phone Number, Position, Years Acquainted

Reference 2

Include Name, Address, Phone Number, Position, Years Acquainted

Reference 3

Include Name, Address, Phone Number, Position, Years Acquainted

Are you able to perform the tasks of the job applied for?*

Yes
No

(This may be with or without accommodation)

Have you ever been convicted of a felony or serious misdemeanor or do you have a case pending?

Yes
No

A conviction will not necessarily disqualify you from employment.

Certification:

I certify that I am eligible to work in the United States and I certify that I have given true, accurate and complete information on this form to the best of my knowledge. I authorize investigation on all statements contained in this application. I understand that misinterpretation, or the omission of any information requested in this application process, may result in dismissal. I authorize all former employers, educational institutions, associations, registration and licensing boards, and others to furnish whatever detail is available concerning my qualifications. Further, I understand and agree that my employment is "at-will" which is for no definite period and may, regardless of the method of payment of my wages or salary, be terminated at any time without cause and without any previous notice. I accept the employer's right to enter into an Alternative Dispute Resolution Procedure to resolve employment disputes.

Have you ever worked on a scaffold?

Yes
No

If so, are you certified?

Yes
No

Have you ever worked on a forklift?

Yes
No

If so, are you certified?

Yes
No

Signature*

Note: Applications are effective for a period of 60 calendar days. Re-apply to maintain an effective application.

How many blocks can you lay a day? (Give an estimate)*

What is the total years you have of experience in masonry work?*

Date*

CAREERS

WORK APPLICATION

Submit Your Application

Schedule an Interview

In-Person Interview

Application Form

NIBBELINK

Personal Information

Education

Former Employment

References

Certification: