Employment Application :: Fitzpatrick & Weller

Employment Application

Fitzpatrick & Weller, Inc. is an equal opportunity employer and affords equal opportunity to all applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, veteran status or any other status protected under local, state or federal laws.

Note to Applicants: You will be required to pass a Post Offer, Pre-Employment Physical including Drug and Alcohol testing prior to Employment.

Positions applied for

Date of application

First Name Required

Last Name Required

Address

Address 1

Address 2

City

State/Province

Country

Postal Code

Email Address:

Phone (Home/Cell) Required

Are you legally eligible to work in the United States?

None

Yes

No

Are you age 18 years or older? Required

None

Yes

No

Can you with or without reasonable accommodation perform essential functions of this job?

None

Yes

No

Have you ever applied to Fitzpatrick & Weller, Inc. before?

None

Yes

No

If Yes, Please explain:

Education

Elementary School / Course of Study or Major / No. of Yrs Completed / Diploma or Degree

High School / Course of Study or Major / No. of Yrs Completed / Diploma or Degree

College / Course of Study or Major / No. of Yrs Completed / Diploma or Degree

Graduate / Course of Study or Major / No. of Yrs Completed / Diploma or Degree

Vocational / Course of Study or Major / No. of Yrs Completed / Diploma or Degree

Please list any academic honors, scholarships, offices held, etc.

Describe any specialized training, apprenticeships, licenses or skills.

Have you received any job-related training in the United States Military?

None

Yes

No

If Yes, please give dates and explanation:

Employment History - Begin with most recent employer

Company Name / Employment dates from/through / Name and Title of Supervisor

Address / Phone

Describe your duties

Reason for leaving and explanation

Company Name / Employment dates from/through / Name and Title of Supervisor

Address / Phone

Describe your duties

Reason for leaving and explanation

Company Name / Employment dates from/through / Name and Title of Supervisor

Address / Phone

Describe your duties

Reason for leaving and explanation

Company Name / Employment dates from/through / Name and Title of Supervisor

Address / Phone

Describe your duties

Reason for leaving and explanation

Company Name / Employment dates from/through / Name and Title of Supervisor

Address / Phone

Describe your duties

Reason for leaving and explanation

Please provide any other information that you feel will help us in considering your application for employment

References (Please list three persons, who are NOT related to you or previous supervisors, who can provide professional references.

Name / Address / Phone / Relationship / Years known

Name / Address / Phone / Relationship / Years known

Name / Address / Phone / Relationship / Years known

Please Read Carefully Before Submitting your application

*** I hereby certify that all information provided by me is correct, accurate and complete to the best of my knowledge. I understand that any falsification, misrepresentation or omission of any facts will be cause for denial of employment or immediate termination of employment regardless of timing or circumstances of discovery.

*** I understand that submission of an application does not guarantee employment. I further understand that should an offer of employment be extended that such employment is, at will, for no specified duration, and may be terminated by either Fitzpatrick & Weller, Inc. or me at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of Fitzpatrick & Weller, Inc. or its representatives used during the employment process is deemed a contract of employment real or implied.

*** I understand that no representation of Fitzpatrick & Weller, Inc. except the President has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the President of Fitzpatrick & Weller, Inc.

*** In consideration for employment, if employed, I agree to conform to the rules, regulations, policies and procedures of Fitzpatrick & Weller, Inc. at all times and understand that such obedience is a condition of employment. I understand that due to the nature of Fitzpatrick & Weller, Inc. business, attendance and punctuality are considered essential requirements for every job at Fitzpatrick & Weller, Inc. and that poor attendance or tardiness will result in disciplinary action.

*** I understand that if offered a position, I may be required to submit to a pre-employment medical examination, drug screening and background check as a condition of employment. I understand unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these tests and checks will result in the withdrawal of any employment offer or termination of employment if already employed. I herby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to Fitzpatrick & Weller, Inc. and/or any representatives, agents or vendors and I release all parties involved from any and all liabilities for any damage that may result from providing such informaiton.

*** I understand that this application is considered current for three months. If I wish to be considered for employment after this period I must fill out and submit a new application.

*** BY SUBMITTING THIS APPLICATION I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD, AND AGREE TO THE ABOVE STATEMENTS.