Gallant Construction

Job Application

IMPORTANT: Applicants with disabilities may request any reasonable accommodation necessary to complete this application, or to take any test required for the position for which the applicant has applied, by making a request at the time of application or testing.

EQUAL EMPLOYMENT OPPORTUNITY. It is our policy to seek and employ the best qualified employees and to provide equal opportunity for the advancement of employees and to administer all of our employment policies in a manner that will not discriminate against any person because of race, color, religion, age, sex, marital or veteran status, national origin, ancestry, disability, on-the-job injuries, or any other legally protected status.

Last Name, First Name, Initial(Please separate by comma)

Date of Application

Street Address, City, State Zip(Please separate by comma)

Date Available

Residence Telephone, Alternative Telephone(Please separate by comma)

Expected Pay Rate

How did you hear about Gallant?

Have you ever worked for us before?

Yes

Are you 18 years of age or older?

Yes

Are you legally authorized to work in the United States?

Yes

If you are hired, are you prepared to present evidence within three days of beginning work showing that you are legal.

Are you available to work out of town?

Yes

Position Application for:

RELATIVES/FRIENDS: Do you have any relatives/friends (such as roommates) who currently work for us?Qualified relatives/friends are eligible for employment except in unusual situations where we need to avoid possible conflicts o

QUALIFICATIONS: please list any education, training (schools, colleges, degrees, licenses, military, etc.)Degrees, Licenses, Relevant Education or Training. Where did you aquire it? (name/address, program, military branch and spcialty

DRIVING POSITIONS: Do you have a valid driver's license?

Yes

(Answer only if driving is an essential function of the job.)

If you have a license, please provide License No./State

Have you ever been CONVICTED, plead GUILTY or NO CONTEST, or FORFEITED BOND OR BAIL for any traffic violations or offenses?

Yes

(In the past three years?)

If yes, to the above question, please give details:

IN CASE OF EMERGENCY NOTIFYName, Address, Telephone

EMPLOYMENT EXPERIENCE 1: Present or Last Employer

Employer Phone

Hire Date/Date Left

Starting Pay/Final Pay

Address

Supervisor

Reason for Leaving

Job Title/Job Duties

EMPLOYMENT EXPERIENCE 2: Previous Employer

Employer Phone

Hire Date/Date Left

Starting Pay/Final Pay

Address

Supervisor

Reason for Leaving

Job Title/Job Duties

EMPLOYMENT EXPERIENCE 3: Previous Employer

Phone

Hire Date/Date Left

Starting Pay/Final Pay

Address

Supervisor

Reason for Leaving

Job Title/Job Duties

Have you ever been terminated (or resigned while facing possible termination or at an employer's request)?

Yes

If yes, to the above question, please explain circumstances:

**Please read below verification, then type full name and date.

There was an error submitting your form

VERIFICATION AND SIGNATURE:

1. I authorize the investigation of all matters which the Company deems relevant to my qualifications for employment, including all information given in this application and in any attachments, supporting documents or interviews. I authorize you to request and receive such information and I release from all liability any current or former employers, other entities (schools, etc.), or persons (such as current or former supervisors, coworkers, etc.), supplying it. I also release you from all liability which might result from making the investigation.

2. I certify that all of the information given in this application and in any attachments, supporting documents or interviews is (or will be) true and complete to the best of my knowledge. I understand and agree that any falsification, misrepresentation or omission, as well as any misleading statements or omissions, generally will result in denial of employment, withdrawal of any offer of employment, or immediate termination, regardless of when and how discovered.

3. I understand and agree that I may be required to submit to pre- or post-employment physical or other professional examinations, medical inquiries and/or urinalysis tests for the presence of drugs and/or alcohol. IMPORTANT: This means that with very few exceptions —an employee will be required to submit to testing in several different circumstances. Ask to see copies of our applicant and employee alcohol and drug policies if you have any questions. I agree to such examinations, inquiries and/or testing at the Company's expense. I authorize release of the results to the Company and their use to evaluate my suitability for employment. I also release the Company from all liability arising out of or connected with any examinations, inquiries and/or testing.

4. I understand and agree that I may resign or be terminated, without cause or notice, at any time, unless otherwise stated in a written employment contract. I also understand and agree that an Owner is the only person who will ever have the authority to agree to any other terms and/or to enter into such contracts, and that all such agreements for other terms of employment or contracts must also be signed by both parties. I also understand and agree that unless otherwise stated in a written employment contract, the Company may change, withdraw and interpret other policies (including wages, hours and working conditions) as it deems appropriate.

5. This application will only be considered active for 60days. I understand that if I have not been contacted by the Company within the 60 days and I still want to be considered for employment, I will need to reapply in writing or apply in person to renew or update my application within five days of the 60-day expiration.

6. I understand and agree that if I am hired the statements in these paragraphs will become a binding part of my employment relationship. I have read each of these statements. I have also reviewed all of the information provided in this application and in any attachments or supporting documents.

job application

Job Application

VERIFICATION AND SIGNATURE: