Application for Employment

APPLICATION FOR EMPLOYMENT
Professional Coatings Applicator

What type of painting work are you interested in:(Required)

Commercial

Industrial

Either

IMPORTANT INFORMATION

Can you show proof of your legal right to work in the United States?(Required)

Yes

Federal law requires employers to verify the identity and legal right to work in the United States.

Can you pass a mandatory drug test?(Required)

Yes

You are required to pass a pre-employment UA and will be subject to random UAs.

You will be paid minimum wage for orientation.

PERSONAL INFORMATION

Last Name(Required)

First Name(Required)

Middle Initial(Required)

Mailing Address(Required)

City(Required)

State(Required)

Zip(Required)

Home Phone:(Required)

Cell:

Email:(Required)

Social Security #:

How did you hear about us?(Required)

Walk-In

Website

Union

Employment Security

Facebook

Indeed

Job Board:

Employee Referral:

Other:

(Location)

(Employee’s name)

Other

Are you a member of a union?

Yes

Once hired you will have 7 days to join the local Painters Union

What trade:

Local:

Have you worked for us before or have you applied with us before?

Yes

When:

Do you have any relatives employed by this Company?

Yes

Who:

Do you have reliable transportation to get to the jobsite on a regular basis?

Yes

Can you pass a background check to get into secure worksites, military installations, or schools?

Yes

Are you willing to work out of state?

Yes

Preferred shift:

Day

Night

Swing

(We do our best to accommodate, but shifts are based on workload.)

Indicate any obligations which prevent you from meeting work attendance requirements. Describe:

Are you able to perform the essential functions of the job without accommodations?

Yes

If no, please identify any accommodations we may make which would better enable you to perform the job:

EMPLOYMENT HISTORY

List most recent first (include volunteer work and military experience)

Employer Name and Address:

Dates Employed Start Date:

MM slash DD slash YYYY

End Date:

MM slash DD slash YYYY

Last hourly rate: $

Specific Duties:

Reason for leaving:

May we contact this employer?

Yes

Supervisor:

Phone:

Employer Name and Address:

Dates Employed Start Date:

MM slash DD slash YYYY

End Date:

MM slash DD slash YYYY

Last hourly rate: $

Specific Duties:

Reason for leaving:

May we contact this employer?

Yes

Supervisor:

Phone:

Employer Name and Address:

Specific Duties:

Reason for leaving:

May we contact this employer?

Yes

Supervisor:

Phone:

PROFESSIONAL REFERENCES

Name

Profession

Phone

EDUCATION

High School:

Date

MM slash DD slash YYYY

Subject/Degree

Graduate or GED?

Yes

College:

Date

MM slash DD slash YYYY

Subject/Degree

Other:

Date

MM slash DD slash YYYY

Subject/Degree

Training certifications or licenses (include Apprenticeship):

Type

Expires

SKILL LEVEL

Check the following you have experience with:

Residential/Light Commercial

Commercial

Lead Man

Business Owner

Industrial

Marine/Shipyards

Foreman

Auto Body

Years

Residential/Light Commercial – Years:

Commercial – Years:

Lead Man – Years:

Business Owner – Years:

Industrial – Years:

Marine/Shipyards – Years:

Foreman – Years:

Auto Body – Years:

Check the skills below that apply to you (Spray List types):

Brush

Sandblasting

Sign Painting

Masking

Hand Taping

Scaffolding

Paint Manufacturing

Epoxy Flooring

Roller

Wallcovering

Estimating

Fireproofing

Machine Taping

Rigging

Swing Stage

Arial Manlifts

Forklift

Scissor Lift

Years

Brush – Years

Sandblasting – Years

Sign Painting – Years

Masking – Years

Hand Taping – Years

Scaffolding – Years

Paint Manufacturing – Years

Epoxy Flooring – Years

Roller – Years

Wallcovering – Years

Estimating – Years

Fireproofing – Years

Machine Taping – Years

Rigging – Years

Swing Stage – Years

Arial Manlifts – Years

Forklift – Years

Scissor Lift – Years

Special Coatings List types:

Other:

Describe non-paint related skills:

Do you have a current first aid/ CPR card?

Yes

Do you have a current TWIC card, Boeing badge, Rapid Gate, or DBIDS?

Yes

Do you have OSHA 30?

Yes

Are you willing to do the following work?

High Work

Yes

Swing Stage

Yes

Confined Space

Yes

While Long Painting provides protective equipment for you, the field of painting can expose you to thinners, solvents, epoxies, and other toxic vapors and dusts. Do you have a medical condition that we need to be made aware of in order to accommodate or to reduce your exposure to hazardous chemicals?

Yes

If so, describe:

VOLUNTARY SURVEY

Government agencies require periodic reports on the sex, ethnicity, disabled, veteran and other protected status of applicants. This data is used for analysis and possible affirmative action only. Applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status.

Gender:

Male

Female

Race:

Caucasian

Black

Hispanic

Asian/Pacific Islander

American Indian/Alaskan Native

Caucasian (Not of Hispanic Origin): All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.
Black (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa.
Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
Asian or Pacific Islander: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands and Samoa.
American Indian/Alaskan Native: All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.

Veteran

Yes

Branch of Service:

Skills:

READ THE FOLLOWING STATEMENTS CAREFULLY

Applicant agrees to the following conditions of employment:

A pre-placement health evaluation, if required, including laboratory testing for drug or alcohol use prior to employment and continued random testing.
Show proof of legal right to work in the United States.
Meeting attendance and performance requirements.
Conforming to the policies and procedures of the company rules, regulations and instructions.
Employment is based on specific project needs and may be terminated as project work force needs dictate.
Any employee who personally, or as a result of instructions to their subordinate(s), pollutes or causes the possibility of injury or damage to the environment, persons or property, with disregard of common sense and/or applicable company, local, state and/or federal laws or regulations, shall be subject to immediate dismissal.

Please read carefully before signing this application. False statements in this application shall be considered sufficient cause for termination.

Signature of Applicant(Required)

Date(Required)

MM slash DD slash YYYY