Online Application

Personal
Required items*

* First Name   * Middle
* Last Name

* Date (mm/dd/yyyy)

* Street Address
*  City    *  State    *  Zip Code

Home Phone   Cell Phone
*Please include area code

*  Social Security Num.   *  Drivers License Num.
Drivers License Endorsements A   B   C   D Other

Position Desired
Pay Expected

Have you ever applied for employment with us? Yes  No
If yes, Month    Year    Location

How did you hear about the company? ie...newspaper, walk in, referral
If you were referred: By Whom
Relationship Are they a current employee of Bomac? Yes  No

Are you available for full time work? Yes  No
If not, what hours can you work?

Will you work overtime, if asked? Yes  No
Are you legally eligible for employment in the United States? Yes  No
When will you be bale to begin work?

Other special training or skills (Languages, machine operation, etc.)

Education

Post Graduate
Name
Course of Study
Num. of Years Completed   Did you Graduate? (yes, no)
Degree or Diploma

College
Name
Course of Study
Num. of Years Completed   Did you Graduate? (yes, no)
Degree or Diploma

High School
Name
Course of Study
Num. of Years Completed   Did you Graduate? (yes, no)
Degree or Diploma

Other
Name
Course of Study
Num. of Years Completed   Did you Graduate? (yes, no)
Degree or Diploma

Address
List all locations where you have lived in the past 7 years.

From   To   City   County   State

From   To   City   County   State

From   To   City   County   State

From   To   City   County   State

Employment History
Please give accurate, complete full-time and part-time employment record. Start with present or most recent employer.

First Most Recent
Company Name
Address
City     State    Zip Code

Name of Supervisor

Telephone
Employed from to

Weekly Pay: Start Last

State Job Title and describe your work

Reason for Leaving

Second Most Recent
Company Name
Address
City     State    Zip Code

Name of Supervisor

Telephone
Employed from to

Weekly Pay: Start Last

State Job Title and describe your work

Reason for Leaving

Third Most Recent
Company Name
Address
City     State    Zip Code

Name of Supervisor

Telephone
Employed from to

Weekly Pay: Start Last

State Job Title and describe your work

Reason for Leaving

We may contact the employers listed above unless you indicate those you do not want us to contact: Employer Number(s) and Reason

Please read the following statements carefully
prior to submitting this application.

I hereby apply for employment with Bo-Mac Contractors, Ltd. (hereinafter referred to as EMPLOYER). I specifically verify that all information provided in the APPLICATION FOR EMPLOYMENT is true, complete and correct. I also verify that I am at least eighteen years of age.

I understand & agree that the omission or misrepresentation of any facts in the APPLICATION FOR EMPLOYMENT will be a sufficient reason for EMPLOYER to deny me employment. I also understand and agree that should I become employed be EMPLOYER and is later discovered I have omitted or misrepresented any fact in this APPLICATION FOR EMPLOYMENT, in any supplement thereto, or any other corporate record, EMPLOYER may

I authorize my employer to obtain a report containing information regarding my prior work-related injuries, claims & lawsuits, driving history and criminal history in connection with evaluating me for employment, promotion, reassignment or retention as an employee.

I will abide by the safety rules of this company. If injured, I authorize my employer to use the best judgment for treatment unless I instruct otherwise.

I agree     *  Date

Verification Information
This information is required for background verification only. It will not be otherwise used in making any hiring decision.
*  Date of Birth *  Social Security Num.   
*  Drivers License Num. *  State Issuing Driver's License
* Drivers License Exp. Date

  
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