Application: Norfolk, VA

Employment Application Virginia

CAPITOL FINISHES, INC.
PRE-EMPLOYMENT APPLICATION

Our company is an equal opportunity employer and will consider all applicants for all positions
equally without regard to their race, sex, age, color, religion, national origin, veteran status, or
any disability as provided in the Americans with Disability Act.
This application will be given every consideration, but its receipt does not imply that the
applicant will be employed. Each question should be answered in a complete and accurate
manner as no action can be taken on this application until all questions have been answered.

Name

First

Last

Address

City

State

Zip

Social Security #

Are you over 18?

Are you a U.S. citizen?

Do you have a legal right to work in the U.S.?

Have you ever been convicted of any crime (excluding minor traffic violations) including DWI?

If yes, state the offense, location, date and disposition

NOTE: A conviction will not necessarily disqualify you from employment.

Would you be willing and able to relocate?

Do you have your own transportation?

Drivers License: State

Drivers License: Tyoe

Drivers License: Valid?

EMPLOYMENT DESIRED

Position Applying For

Desired Salary

Available to start on

Have you ever applied to our company before?

Have you ever worked for our company before?

If you answered yes to either of these questions, state when and where you applied and/or worked.

How did you learn of our company and/or position?

Are there any days or hours you would be unable or unwilling to work? Please specify

Are you willing and available to travel at the company’s expense to our other locations when work scheduling necessitates it?

EDUCATION

High School

Dates

Courses Studied

Diploma?

College

Dates

Courses Studied

Diploma?

Trade School

Dates

Courses Studied

Diploma?

If you did not graduate, why did you leave high school or college?

List any scholastic honors, offices held, and activities involved in during high school and college.

List and describe any other school or specialized training.

MILITARY

Have you ever served in the military?

Service/Branch

Date Entered

Date Seperated

If yes, please explain

Final Rank

SPECIAL SKILLS

Use the space below to list your special skills and describe why you are interested in working for our company and to list those skills and abilities which you feel particularly qualify you for a position with us. If you need more space, please continue on a separate sheet.

CAPABILITY/RELIABILITY

Would you be willing and able to perform all of the tasks required by the job you are applying for?

If not, explain which tasks

Have you filed any type of fraudulent claim against any of your present or past employers? If yes, explain.

Will you abide by the safety rules of this company?

Have you ever been disciplined for violating company safety rules or regulations?

If yes, explain.

How many days of work (or school) have you missed in the last two years?

How many times have you been late for work (or school) in the last two years?

Dropdown

If no, explain.

WORK HISTORY

List names of employers in consecutive order with your present or last employer listed first.
Account for all periods of time including military service and any periods of unemployment. If
self-employed, give firm name and supply business references. Please give month and year. Do
not reference your resume.

Business Name

Name and Title of Last Supervisor

Address

Phone

Dates of Employment

Starting - Ending Salary

Your Duties

Reason for Leaving

If you have worked in any of your previous positions under another name, please give that name(s)

May we contact your present employer?

Have you ever been fired or asked to resign from a job?

REFERENCES

Please give three references, not relatives or former employers.

Name

Location

Phone

Occupation

Name

Location

Phone

Occupation

Name

Location

Phone

Occupation

UNDER MARYLAND LAW AN EMPLOYER MAY NOT REQUIRE OR DEMAND ANY APPLICANT
FOR EMPLOYMENT OR PROSPECTIVE EMPLOYMENT OR ANY EMPLOYEE TO SUBMIT TO OR
TAKE A POLYGRAPH LIE DETECTOR TEST OR OTHER EXAMINATION AS A CONDITION OF
EMPLOYMENT OR CONTINUED EMPLOYMENT. ANY EMPLOYER WHO VOILATES THIS
PROVISION IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT TO EXCEED $100.

AFFIDAVIT
I certify that my answers to the foregoing questions are true and correct without any
consequential omissions of any kind whatsoever. I understand that if I am employed, any false,
misleading, or otherwise incorrect statements made on this application form or during any
interviews may be grounds for my immediate discharge.
I hereby authorize the Company to contact any company or individual it deems
appropriate to investigate my employment history, character and qualifications and I give my
full and complete consent to their revealing any and all information they wish as a result of this
investigation. In addition, I hereby waive my right to bring any cause of action against these
individuals for defamation, invasion of privacy or any other reason because of their statements.
I agree that if I am employed, I will abide by all the rules and regulations of the
Company. I understand that the taking of drug and alcohol tests when given pursuant to
Company policy, are a condition of continued employment and refusal to take such tests when
asked will be grounds for my immediate termination. I further understand that nobody in the
Company is authorized to enter into any written and verbal employment contracts with me for
any definite period of time without the express written consent of the Board of Directors. I also
understand that my employment is “at-will” and may be terminated by myself or by the
Company at any time for any reason or no reason at all with or without prior notice.

Type Your FULL NAME to Agree to the Above.

Todays Date

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CAPITOL FINISHES, INC.PRE-EMPLOYMENT APPLICATION

EMPLOYMENT DESIRED

EDUCATION

MILITARY

SPECIAL SKILLS

CAPABILITY/RELIABILITY

WORK HISTORY

REFERENCES

CAPITOL FINISHES, INC.
PRE-EMPLOYMENT APPLICATION