Job Application

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1
Job Application

It is the policy of this company to provide equal employment opportunity to a qualified applicant without regard to race, color, religion, sex, sexual orientation, national origin, age, marital status, veteran status, non-job disability, or any other protected group status.  The Company to which you are applying for employment strives to maintain a drug and alcohol free workplace.  We reserve the right to administer our substance abuse policy and to test candidates prior to hiring them for prohibited drugs and/or alcohol.

Position Applying For
Date

Personal Information
Nameyour full name
Full Address
0 /
PhoneBest # to reach you
Date available to work
Do you have a valid driver's license?
Statefor license
Classfor license
Are you a U.S. Citizen or otherwise authorized to work in the United States on an unrestricted basis?
How did you learn of our organization?
0 /
Have you ever applied for employment with us?
If yes, month, year, and position
0 /
State names of relatives and friends working for us.
0 /
Have you been convicted of a crime in the past ten years, which has not been annulled, expunged or sealed by a court?
If you answered yes, explain in full:
0 /

Education
High SchoolAttended
High School Address
0 /
Course of Study
Numbers of YearsCompleted
Did You Graduate HS?
Degree/Diploma

College/UniversityAttended
College/University Address
0 /
Course of Study
Numbers of YearsCompleted
Did You Graduate College/University?
Degree/Diploma

Technical/VocationalAttended
Technical/Vocational Address
0 /
Course of Study
Numbers of YearsCompleted
Did You Graduate Technical/Vocational?
Degree/Diploma

Military
Branch of Service
Active DutyYears
0 /
Date of Discharge
Rank at Discharge
Describe your duties and any special training
0 /

Employment
Employer 1
Phone number
Address
0 /
Position
Rate of pay
Dates of Employment
0 /
Name of Supervisor
Reason for leaving?
0 /
If Commercial driver, subject to FMCSR while employed?
Subject to Drug and Alcohol testing?
Job title and description of duties
0 /

Employer 2
Phone number
Address
0 /
Position
Rate of pay
Dates of Employment
0 /
Name of Supervisor
Reason for leaving?
0 /
If Commercial driver, subject to FMCSR while employed?
Subject to Drug and Alcohol testing?
Job title and description of duties
0 /

Employer 3
Phone number
Address
0 /
Position
Rate of pay
Dates of Employment
0 /
Name of Supervisor
Reason for leaving?
0 /
If Commercial driver, subject to FMCSR while employed?
Subject to Drug and Alcohol testing?
Job title and description of duties
0 /

Have you ever been discharged or reprimanded for violating a safety policy?
If you answered yes, explain in full
0 /
Please describe any special training or skills (languages, machine operations, etc.)
0 /

References
Reference 1 Name
Reference 1 Phone
Reference 2 Name
Reference 2 Phone
Reference 3 Name
Reference 3 Phone

I certify that any answers and statements on this application form and any supplemental forms are true and complete to the best of my knowledge.  If employed, I understand that any false statements or omission of facts on this application will be considered sufficient cause for my dismissal.  I hereby authorize this company to investigate any aspect of my prior education, employment history, driving record, safety performance history or other information that may be necessary in arriving at an employment decision.  Furthermore, I understand that if I am hired, employment with this company is “at will”, which means that either the company or I can terminate employment for any reason not prohibited by state or federal law.  I confirm that this form has been completed by me.

Acknowledgement
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Contact Us

Phone: 540.825.3370

Fax: 540.825.8603

Mailing Address:
Cedar Mountain Stone Corp.
P.O. Box 12
Mitchells, VA 22729