C S Beatty Construction, Inc.

EMPLOYMENT APPLICATION AND AGREEMENT

NOTICE TO
APPLICANTS

WE WILL NOT USE THE INFORMATION ON THIS APPLICATION TO DISCRIMINATE AGAINST ANY INDIVIDUAL WITH RESPECT TO THEIR COMPENSATION, TERMS, CONDITIONS, OR PRIVILEGES OF EMPLOYMENT BECAUSE OF RACE, COLOR, RELIGION, SEX, AGE, NATIONAL ORIGIN, OR PHYSICAL HANDICAP.

GENERAL INFORMATION(Complete in full) (*) indicates mandatory

* Position currently held or applying for :
* Date : (mm-dd-yyyy)
* Last Name :
* First Name :
Middle Name :
Address :
* City :
* State :
* Zip Code :
Phone (area code) :
* Social Security Number :

Indicate school level reached: (circle) High School: College:

Do you have your own car? : Yes No

Car Insured? : Yes No

Driver's License : State : License Number : Exp Date :

Have you. since the age of 18. ever been convicted of a misdemeanor or felony? (Note: A Conviction will not necessarily bar you from employment. Each conviction will be judged on its own merits with respect to time, circumstances and seriousness.) Yes No

Are you 18 years of age or older? Yes No

FORMER EMPLOYERS List Below Last Employers Starting With Last One First Must Be Filled Completely

Date Month/Year	Name and Address of Employer	Salary	Position	Reason For Leaving

From: To:

From: To:

From: To:

If there are any work skills which you feel particularly qualified and/or have experience please list here:

CHARACTER REFERENCES
List three persons not related to you,whom you have know atleast one year :

Name	Address & Telephone	Occupation

1.

2.

3.

EMERGENCY INFORMATION
Name,address,&telephone number of nearest relative not residing with you :
Name:
Address:
City:	State: Zip:
Realtionship:	Telephone:

Acknowledgement of the Drug Free Workplace Program

I understand that C.S. Beatty Construction, Inc. (the Company) maintains a Drug Free Workplace policy requiring all employees to report to work in a substance free condition. I understand that as a condition of my initial and/or continued employment and where reasonable suspicion of drug use exists, the Company will require me to undergo substance screening by urinalysis, blood (for alcohol), hair follicle, or other testing procedure and I hereby agree to submit to such tests, including post rehabilitation periodic testing and the required post accident testing. I further consent to the results of any such drug screen(s) being released to the Company�s authorized representative by the Medical review Officer, and understand that I am legally authorized to receive a copy of this consent form if requested. The results will not be released to any additional parties without my written authorization. I also understand that the Drug Free Workplace Policy and related documents are not intended to constitute a contract between me and the Company

* Click to acknowledge

Notice Regarding Background Investigation

C.S. Beatty Construction, Inc. (the Company) may obtain information about you from a consumer reporting agency for reporting purposes. Thus, you may be the subject of a �consumer report� and/or an �investigative consumer report� which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may include employment history and reference checks, criminal and civil litigation history information, motor vehicle records (�driving records�), sex offender status, credit reports, education verification, professional licensure, drug testing, Social Security Verification, and information concerning workers� compensation claims (only once a conditional offer of employment has been made).

* Click to acknowledge

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