Job Application Form

Please note, fields marked with a * are required.

Part 1 - Documents

If you have a resume, use this link to upload it. (Microsoft Word, Plain Text, and PDF Accepted)

If you have a cover letter, use this link to upload it. (Microsoft Word, Plain Text, and PDF Accepted)

Part 2 - Identification

First Name *

Last Name *

Address *


City *

State *

Zip Code *

Phone Number *

Your Email

What position are you applying for? *

Desired Salary*

Driver’s License Number if relevant to job

State

Expiration Date

Part 3 - Qualifications

How many years of related experience do you have?*

How were you referred to us?

If you are under 18, can you provide a work permit?*
YesNoNot Applicable
If no, please explain

Have you ever applied to Concrete Protection & Restoration Inc. before?*
YesNo

Have you ever worked for Concrete Protection & Restoration Inc. before?*
YesNo
If yes, when?

When can you start?

Can you perform the essential functions of the job with or without reasonable accommodation?*
YesNo

Are you a citizen of the United States?*
YesNo
If not, are you legally allowed to work in the United States?*
YesNoNot Applicable

Type of employment desired?*
Full TimePart TimeSeasonal

Have you ever pleaded guilty, no contest, or been convicted of a crime?*
YesNo
If yes, please give details.

Answering yes to these question does not constitute an automatic rejection for employment. Date of offense, seriousness, and nature of the violation, rehabilitation, and position applied for will be considered.

Summarize your special skills or qualifications (please fill out if you did not upload a resume)

Part 4 - Job History

(begin with most recent position)*

Previous Employment

Dates of Employment*

Positions Held*

Company Name*

Address*

City*

State*

Zip*

Phone*

Supervisor*

Supervisor's Title*

Responsibilities*

Starting Salary and Title*

Ending Salary and Title*

Reason for Leaving*

May we contact this employer for a reference?*
YesNo

Previous Employment

Dates of Employment

Positions Held

Company Name

Address

City

State

Zip

Phone

Supervisor

Supervisor's Title

Responsibilities

Starting Salary and Title

Ending Salary and Title

Reason for Leaving

May we contact this employer for a reference?
YesNo

Previous Employment

Dates of Employment

Positions Held

Company Name

Address

City

State

Zip

Phone

Supervisor

Supervisor's Title

Responsibilities

Starting Salary and Title

Ending Salary and Title

Reason for Leaving

May we contact this employer for a reference?
YesNo

Part 5 - Signature

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial, and other related matters as may be necessary for an employment decision. I hereby release employers, schools, or individuals from all liability when responding to inquiries in connection with my application.
In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

Name*

Date*

 

Having trouble submitting this form? You may print the form, and fax it to 410-298-4086, or scan and email it to info@www.concretecpr.com.