Paragon Restoration II Inc. Application

Please complete this form. Individuals who need assistance with any phase of the application process should notify our office at 952-435-4354 to request reasonable accommodations. Provide all requested information to the best of your ability. Failure to do so may result in disqualification of your application. Some packets may include an EEO Self-Identification Form. This information is being gathered for federal record-keeping and/or affirmative action purposes only. The information requested is voluntary and will be kept confidential. An applicant will not be subject to any adverse treatment for refusing to complete the questionnaire. Paragon Restoration II, Inc. is an equal opportunity employer and does not discriminate against any applicant or employee because of race, color, religion, gender, national origin, age, disability, veteran status, citizenship, or any other characteristic protected by federal, state, or local law.

General Information

Position Applied For

Todays Date * +

Name (First, Last) *

Current Address: Street *

City *

State *

Zip *

Cell Phone *

Home Phone

Email Address

Are you at least 18 years of age? *

Yes

Are you legally eligible to work in the United States? (Proof of employment eligibility will be required if hired.) *

Yes

Availability

What date can you start? +

What category would you prefer? *

Full Time

Part Time

Temporary

Labor Pool

*Reasonable efforts will be made to accommodate sincerely held religious beliefs.

Essential Job Functions

While performing the duties of the job for which you are applying, the employee may be frequently required to do the following:

Lift and carry heavy objects up to 70 lbs
Bend, kneel, and/or work in restricted spaces.

Are you able to perform the physical requirements and job essential functions, listed above, with or without reasonable accommodation? *

Yes

Reference 1

Name

Address

Phone

Years Known/Relationship

Reference 2

Name

Address

Phone

Years Known/Relationship

Reference 3

Name

Address

Phone

Years Known/Relationship

Education

Please check the highest grade completed

If your school records are under a different name than listed above, please enter that name

High School Name

College / Trade School Name

Most Recent Employer

Are you currently working for this employer?

Yes

If yes, may we contact them?

Yes

Company Name

City

State

Dates Employed

Job Title

Supervisor Name

Duties

Salary

Per

Reason for Leaving

Second Most Recent Employer

Are you currently working for this employer?

Yes

If yes, may we contact them?

Yes

Company Name

City

State

Dates Employed

Job Title

Supervisor Name

Duties

Salary

Per

Reason for Leaving

Third Most Recent Employer

Are you currently working for this employer?

Yes

If yes, may we contact them?

Yes

Company Name

City

State

Dates Employed

Job Title

Supervisor Name

Duties

Salary

Per

Reason for Leaving

Driver's License Information

If the job requires, do you have the appropriate valid driver’s license?

Yes

Name on License

Type

Have you had any moving violations within the last seven years?

Yes

If yes, please describe

Criminal History

Please note that a “Yes” answer to any of the following questions will not necessarily disqualify you from employment. Factors such as the age and time of the offense, seriousness and nature of the violation, and rehabilitation will be considered when making any employment decisions.

Answer Below

Have you ever been convicted of or pleaded guilty to a crime? Do not include convictions that were sealed, erased, annulled or expunged pursuant to a court order. *

Yes

Please explain any “Yes” answer.

Are you currently awaiting trial for any criminal offense? *

Yes

Please explain any “Yes” answer.

Other

Is there anything else you'd like us to know about you that may not have been asked?

Sign Below

*I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that the omission of fact, misrepresentation, providing false or misleading information given in my application, or my resume, or during any stage of the hiring process may result in termination of my employment.

Signature *

Date +