Employment Form Don Luchetti Construction565 Distribution DrMelbourne, FL 32904 We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the organization. If offered a position and prior to hiring, all applicants will be verified in e-Verify System and will be sent for drug testing.Name* First Last Position(s) applied for or type of work desired* Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Alt. PhoneEmail* Social Security Number* Type of Employment Desired?*Full-timePart-timeTemporaryAre you able to meet the attendance requirements?* Yes No Do you have any objection to working overtime if necessary?* Yes No Do you have your own transportation?* Yes No Can you travel if required by this position?* Yes No Have you ever been previously employed by our organization?* Yes No Can you submit proof of legal employment authorization and identity?* Yes No If you are under 18, can you furnish a work permit if it is required?* Yes No Have you ever been convicted of a crime in the last 7 years?* Yes No If yes, please explain (a conviction will not automatically bar employment):* Drivers license number (if driving is an essential job duty): How were you referred to us? Educational HistoryList school name and location, years completed, course of study, and any degrees earned:Highschool* Did you graduate? Yes No College Did you graduate? Yes No Other Did you graduate? Yes No Previous EmploymentEmployer 1* Title* Start Date End Date Salary/Hourly rate Employer 2 Title Start Date End Date Salary/Hourly rate Employer 3 Title Start Date End Date Salary/Hourly rate Other Skills and QualificationsSummarize any job-related training, skills, licenses, certificates, and/or other qualifications:ReferencesList 3 references names, telephone numbers, and years known (do not include relatives or employers): Upload a resumeMax. file size: 2 MB.Disclaimer & Signature I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information. I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered. If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law. I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person’s need for a reasonable accommodation as required by the ADA. I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment. I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.This Application Is Not Complete WIthout Your Signature* Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.