DP Sawyer » Employment Application

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Employment Application

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D.P. Sawyer, Inc. is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.
Applicant Information
Applicant Name:*
First Last
Address:*
Street Address City State ZIP Code
Phone Number:*
Alternate Number:
Email:
Date of Application:
DD slash MM slash YYYY
Employment Position
Position(s) Applying for:*
Salary desired:*
How did you hear about this position?*
On what date can you start working if you are hired?*
DD slash MM slash YYYY
If necessary for the job, are you available to:
Work Overtime?
- Yes
- No
Work Nights?
- Yes
- No
Work Weekends?
- Yes
- No
Travel Overnight?
- Yes
- No
Personal Information
Have you ever worked for this D.P. Sawyer, Inc. before?*
- Yes
- No
If yes, when?
DD slash MM slash YYYY
Do you have any friends, relatives or acquaintances working for D.P.Sawyer, Inc?
- Yes
- No
If yes, state name & relationship:
Are you a U.S. citizen or approved to work in the United States?*
- Yes
- No
Do you have any condition which would require job accommodations?*
- Yes
- No
If yes, please describe accommodations required:
Will you consent to a controlled substance test?
- Yes
- No
Have you been convicted of a felony within the last 5 yrs?
- Yes
- No
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)
If so please explain:
Job Skills/ Qualifications
Please list below the skills and qualifications you possess for the position for which you are applying:
Are you capable of lifting 50 lbs?
- Yes
- No
Do you have a valid Driver's License?
- Yes
- No
Do you have a Commercial Driver's License?
- Yes
- No
Education and Training
High school:
Location:
City, State
Year Graduated:
Degree Earned:
Vocational School/Specialized Training:
Location:
City, State
Year Graduated:
Degree Earned:
College:
Location:
Year Graduated:
Degree Earned:
Employment History
List last three employers, starting with the most recent
Employer Name:
Employer Address:
Street Address Address Line 2 City State ZIP Code
Position Title:
Duties/ Skills:
Supervisor:
Telephone:
Starting date:
DD slash MM slash YYYY
Leaving date:
DD slash MM slash YYYY
Pay Rate:
Reason for leaving:
Employer Name:
Employer Address:
Street Address Address Line 2 City State ZIP Code
Position Title:
Duties/ Skills:
Supervisor:
Telephone:
Starting date:
DD slash MM slash YYYY
Leaving date:
DD slash MM slash YYYY
Pay Rate:
Reason for leaving:
Employer Name:
Employer Address:
Street Address Address Line 2 City State ZIP Code
Position Title:
Duties/ Skills:
Supervisor:
Telephone:
Starting date:
DD slash MM slash YYYY
Leaving date:
DD slash MM slash YYYY
Pay Rate:
Reason for leaving:
Summarize other employment related to this job:
References
(Please list names, telephone #’s, and yrs. acquainted, of 3people.)
Name:
Telephone Number:
Relationship:
Years Known:
Name:
Telephone Number:
Relationship:
Years Known:
Name:
Relationship:
Telephone Number:
Years Known:
Authorization
As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job.
If necessary for employment, you may be required to supply your birth certificate or other proof of authorization to work in the United States and/or have a drug test. A Motor Vehicle Record and a felony background inquiry will be submitted for all applicants prior to hire.
No representative of the company has any authority to enter into any agreement for the employment for a specific period of time, or make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative
- I understand and agree to the information shown above.

D.P. Sawyer, Inc. requires Motor Vehicle Record (MVR) checks and felony background inquiries on all employees.
Provisions of Section 604 and 607 of the Federal Fair Credit Reporting Act, Public Law 91-508, require that we inform you that an inquiry is being made and a report will be prepared by an outside organization at D.P. Sawyer’s request which will provide information as to your driving record and/or whether you have been indicted or convicted of a felony in any court.
Your signature will constitute a blanket authority for continuing inquiries until you leave D.P. Sawyer, Inc. employment.
This information will be used for a “permissible purpose” as defined in the Act, and the information received will be used for no other purpose. If you are denied initial or continued employment based on the information received, you have the right to request information from the outside organization conducting the inquiries.
Your signature below indicates that you understand that as checked above, a MVR and/or a felony inquiry will be conducted as a condition of employment, and that you have the right to request additional information from the outside organization conducting the inquiries.
MVR and Felony Inquiry Agreement
- I have read and agree
Employee Name:
First Last
Email:*
Address(es) (3 year history):
Address
Street Address Address Line 2 City State ZIP Code
Address
Street Address Address Line 2 City State ZIP Code
Address
Street Address Address Line 2 City State ZIP Code
Date of birth:
MM slash DD slash YYYY
Social Security Number:
Drivers License State & Number (3 year history):
Drivers License State:
Drivers License Number:
Drivers License State:
Drivers License Number:
Drivers License State:
Drivers License Number:
Email
This field is for validation purposes and should be left unchanged.

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DP SAWYERBARRICADES INC. 4535 NORTH 62ND STREET LINCOLN, NE 68507-1218 402.466.3354

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