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Berglund Construction Online Job Application

It is the policy of Berglund Construction Company to consider all applicants without regard to race, religion, color, sex, age, marital status, national origin or disability.

Please complete all items. All items with an * are required

* Position applied for:

Date:

(MM/DD/YYYY)

Union affiliation

* Local #:

* Years as a member:

Apprentice % of pay # of years

Journeyman

Personal information

* Name:

First MI Last

* Social Security number:

- -

* Address:

Street

City State

Zip

* Phone:

Home phone Cell phone

E-mail:

* Are you over the age of 18?

Yes No

If no, please state your date of birth:

(MM/DD/YYYY)
Note: If hired, you are required by law to submit proof of identity and eligibility to work in the U.S.

* Have you ever been employed by a Berglund company?

Yes No

If yes, provide date(s) and position(s):

* Do you have friends/relatives employed by a Berglund company?

Yes No

If yes, please provide name(s) and relationship(s):

* Do you speak English:

Yes No

* Are you capable of performing the essential functions of the job for which you are applying with reasonable accomodation?

Yes No

If no, please describe:

* Have you ever been convicted of a felony or a DUI?

Yes No

If yes, please describe in detail:

Note: Disclosure of a criminal record will not necessarily disqualify you from employment. The nature of the offense, date and the position for which you are applying will also be considered.

Education data

High School

* Name of school attended:

* Address:

* Dates attended:

to (MM/YYYY)

* Did you graduate?

Yes No

College

Name of school attended:

Address:

Dates attended:

to (MM/YYYY)

Did you graduate?

Yes No

Type of degree/diploma received:

Major/minor fields of study:

Other

Name of school attended:

Address:

Dates attended:

to (MM/YYYY)

Did you graduate?

Yes No

Type of degree/diploma received:

Major/minor fields of study:

Employment record

Position 1

* Company name:

* Address:

* Phone:

* Dates of employment:

to (MM/YYYY)

Supervisor:

Job title:

Weekly pay:

* Description of work:

* Reason for leaving:

Position 2

Company name:

Address:

Phone:

Dates of employment:

to (MM/YYYY)

Supervisor:

Job title:

Weekly pay:

Description of work:

Reason for leaving:

Position 3

Company name:

Address:

Phone:

Dates of employment:

to (MM/YYYY)

Supervisor:

Job title:

Weekly pay:

Description of work:

Reason for leaving:

Request for training information

List special classes or seminars that you have attended. You must be able to provide proof of attendance, such as a certificate or a card.

Any other special training you have received:

Applicant’s acknowledgement

In connection with my application for employment, I understand that a consumer report may be requested that will include information as to my character, work habits, performance and experience, along with reasons for termination from past employment. According to the Fair Credit Reporting Act, I am entitled to know if employment is denied because of information obtained by my prospective employer from a Consumer Reporting Agency. If so, I will be notified and given the name of the agency or the source that provided the information.

As allowable by union agreements, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. I agree to undergo a pre-employment drug/alcohol test. I understand that if I refuse to consent to testing, fail to provide a urine sample when requested, provide a false or tampered urine sample or fail to successfully complete the drug/alcohol test, I will not be hired in accordance with Berglund’s policy.

I understand that my employment application and any other company documents are not a contract of employment and that any individual who is hired may voluntarily leave or be terminated at any time, with or without cause.

I understand that as directed by company policy and consistent with the job requirements, you may be requesting information from public and private sources about my: workers compensation injuries, driving record, court record, education, credentials, credit and references.

Medical and workers’ compensation information will only be requested in compliance with the Federal American’s with Disabilities Act (ADA) and/or any other applicable state laws.

I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, reference or insurance company contracted by Berglund Construction Company or its agency, to furnish the information described above.

I hereby authorize release of information from my Department of Transportation regulated drug and alcohol testing records by my previous employer to Berglund Construction. This release is in accordance with DOT Regulation 49CFR Part 40, Section 40.25. I understand that information to be released by my previous employer, is limited to the following DOT-regulated items, alcohol tests with a result of 0.04 or higher, verified positive drug tests, refusals to be tested, other violations of DOT agency drug and alcohol testing regulations, information obtained from previous employers of a drug and alcohol rule violation and any documentation of completion of the return-to-duty process following a rule violation.

This information is confidential and will not be used for any other purposes. I hereby release the employer and agents and all persons, agencies and entities providing information or reports about me from any and all liability arising out of the requests for a release of any of the above-mentioned information or reports. The Fair Credit Reporting Act gives you specific rights in the dealing with consumer report agencies. You will find these rights in the “Summary of Your Rights under the Fair Credit Reporting Act” document at www.ftc.gov/credit.

I certify that all statements made by me on this application are true and correct to the best of my knowledge and belief. I understand that any false, inaccurate or omitted material statements could, in fact, be cause for rejection of my application or termination of my employment at any time.

I have read, understand and, by my initials and date of birth, consent to these statements.

* * Date of birth: MM/DD/YYYY