English Application

Position Title

Wage Desired

Date Available

Please Print Personal Information (necessary Accommodations For Participation In The Application Process May Be Requested.)

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Agency

Other

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(Convictions will not necessarily disqualify an applicant from employment.) If yes, please state the offense/location/date/disposition:

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(Please list any additional information that relates to your ability to perform the job for which you have applied.)

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Branch of Service

From

To

Rank/Type of Service

Job-Related Training/Experience

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Name of School

Address

Area of Study/ Major

Highest Grade Completed

Diploma/GED

GPA

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Name of School

Address

Area of Study/ Major

Dates Attended

Degree/Certificate

GPA

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Name of School

Address

Area of Study/ Major

Dates Attended

Degree/Certificate

GPA

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Name of School

Address

Area of Study/ Major

Dates Attended

Degree/Certificate

GPA

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Please list any additional information that relates to your ability to perform the job for which you have applied-- such as licenses, certifications (e.g., welding, apprenticeship or journeymen card), professional memberships, computer experience, special tools/equipment, technical skills, etc.

(List most recent employment first.)

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Present Employer

From: Mo./Yr.

To: Mo./Yr.

Job Title

Supervisor’s Name and Title

Brief Description of Duties

Start Wage

Current Wage

Reason for Wanting to Make a Change

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From: Mo./Yr.

To: Mo./Yr.

Job Title

Supervisor’s Name and Title

Brief Description of Duties

Start Wage

End Wage

Reason for Leaving

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License #

State Issued

Classification

Issue Date

Expiration Date

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Name

Occupation

Years Known

Belfast valley contractors, inc. (bvc) is a drug- and alcohol-free workplace. To ensure Worker safety and integrity of the workplace, bvc prohibits the illegal manufacture, Possession, distribution or use of controlled substances in the workplace by employees Or those who engage or seek to engage in business with bvc. An offer of employment may Be contingent upon passing a drug screening that may include alcohol testing or a Physical examination

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Applicant’s Signature

Polygraph protection for applicants in maryland: please read and sign Under maryland law, an employer may not require or demand, as a condition of Employment, prospective employment, or continued employment, that an individual submit To or take a lie detector or similar test. Any employer who violates this law is guilty of a Misdemeanor and subject to a fine not exceeding $100.

Applicant’s Signature

I understand that belfast valley contractors, inc. (bvc) follows an employment-at-will Policy, in that bvc or i may terminate my employment at any time, or for any reason Consistent with applicable state or federal law. The employment-at-will policy cannot be Changed verbally or in writing, unless the change is specifically authorized in writing by The president of bvc. I understand that this application, company manuals, employee Handbooks or human resources guidelines and practices will not constitute a contract of Employment. I understand that federal law prohibits the employment of unauthorized Aliens. All persons hired must submit satisfactory proof of both identity and employment Authorization, and failure to submit such proof will result in denial of employment. I understand that belfast valley contractors, inc. (bvc) will thoroughly investigate my Work and personal history and verify all data given on this application, on related papers, And in interviews. I authorize all indiv

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Applicant’s Signature

This application will be active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

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Interviewer

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Job Title

Hourly Rate/Salary

Department

Disclosure, authorization and release to procure background information

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In connection with my application for employment with Belfast Valley Contractors, Inc. (BVC) and/or as consideration for continued employment, I understand that BVC may obtain one or more consumer reports and/or investigative consumer reports containing information from one or more consumer reporting agencies (“Agency”). The information about me provided in these reports will be used for the purpose of evaluating my employment, promotion, transfer, reassignment, or retention as an employee. These above-mentioned reports may include, but are not limited to, information as to my character, general reputation, and personal characteristics, discerned through employment and education verifications (to include transcripts and GPA); personal references; personal interviews; my personal credit history based on reports from any credit bureau; my driving history, including any traffic citations; a social security number trace; present and former addresses; criminal and civil history/records; any

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I hereby authorize belfast valley contractors, inc. (bvc) to procure consumer reports and/or Investigative consumer reports from an agency as part of the investigation into my application for Employment and/or at any time while employed by bvc. This authorization does not include the Release of my medical information. I further authorize any person, business entity or governmental agency who may have information Relevant to the above to disclose the same to belfast valley contractors, inc. (bvc), by and through an Agency, including, but not limited to any and all courts, public agencies, law enforcement agencies And credit bureaus, regardless of whether such person, business entity or governmental agency Compiled the information itself or received it from other sources.

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Signature

Other Names Used (alias, maiden, nickname)

Years Used

Social Security Number

Gender

* This information will allow us to properly identify you in the event we find adverse information during the course of a background search

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Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

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You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: Blindness,Autism ,Bipolar disorder,Post-traumatic stress disorder (PTSD),Deafnes,Cerebral palsy,Major depression ,Obsessive compulsive disorder,Cancer,HIV/AIDS,Multiple sclerosis (MS),Impairments requiring the use of a wheelchair,Diabetes,Epilepsy,Schizophrenia,Muscular,dystrophy,Missing limbs or,partially missing limbs,Intellectual disability (previously called mental retardation)

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Applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, age, national origin, pregnancy, sexual orientation, marital or family status, physical or mental disability, uniformed service, protected veteran status, genetic information or any other characteristic protected by federal, state or local law provided the individual can perform the essential functions of the job with or without reasonable accommodations; and such accommodation, does not result in undue hardship or financial burden on the conduct of the business or endanger safe performance of the job. As a government contractor/subcontractor, we comply with the government regulations and affirmative action responsibilities. Solely to help us comply with government recordkeeping, reporting and other legal requirements, please complete this Applicant Data Record. Your cooperation is greatly appreciated. This data is for periodic government reporting and

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Position(s) Applied For

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Other

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Government agencies require periodic reports on the sex, ethnicity, and veteran status of applicants. This data is for analysis and affirmative action only.

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Check one of the following items in each category:

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