Employment

Home
Employment

Employment Application Form

The Employment Form is your gateway to joining our dynamic team. Streamlined and user-friendly, it captures essential details to match your skills with our opportunities.

Smith Construction Services

Employment application

Applicant Information

Full Name:				Date:*
	Last*	First	M.I.

Address:
	Street Address	Apartment/Unit #


	City	State	ZIP Code

Phone:

Email:

Date Available:

Social Security No.:

Desired Salary: $

Position Applied For:

	YES	NO		YES	NO
Are you a citizen of the United States?			If no, are you authorized to work in the U.S.?

	YES	NO
Have you ever worked for this company?			If yes, when?

	YES	NO
Have you ever been convicted of a felony?

If yes, explain:

Education

High School:

Address:

					YES	NO
From:		To:		Did you graduate?			Diploma:

College:

Address:

					YES	NO
From:		To:		Did you graduate?			Degree:

Other:

Address:

					YES	NO
From:		To:		Did you graduate?			Degree:

References

Please list three professional references.

Full Name:

Relationship:

Company:

Phone:

Address:

Full Name:

Relationship:

Company:

Phone:

Address:

Full Name:

Relationship:

Company:

Phone:

Address:

Previous Employment

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From:

To:

Reason for Leaving:

	YES	NO
May we contact your previous supervisor for a reference?

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From:

To:

Reason for Leaving:

	YES	NO
May we contact your previous supervisor for a reference?

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From:

To:

Reason for Leaving:

	YES	NO
May we contact your previous supervisor for a reference?

Military Service

Branch:

From:

To:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or
interview may result in my release.

Signature:

Date:

WORKWELL,TX

Employee Acknowledgment of Workers' Compensation Network

I have received information that informs me how to get health care under my emainver's workers compensation insurance.

If I am hurt on the job and live in a service area described in this packet, I understand that:

I must choose a treating doctor from the list of doctors in the network. Or, I may ask my MMO primary care physician to agree to serve as my dreading doctor if I select my rivo primary care physician as my treating doctor, I will call Texas Mutual Insurance Company at (844) 367-2338 to notify them of my choice.

I must go to my treating doctor for all health care for my injury. If I need a specialist, my treating doctor will refer me to a specialist. If I need emergency care, I may go anywhere. Texas Mutual will will pay the treating doctor and other network providers for the troutment for my compensable injury.

I may have to pay the bill if I get health care from someone other than a network doctor without prior network approval.

Knowingly making a false workers' compensation claim may lead to a criminal investigation that could result in criminal penalties such as fines and imprisonment.


Signature	Date	Printed name

I live at:
	Street address


	City	State	ZIP Code

Name of employer:

Name of network: WorkWell, TX

To the employer:

Each employee must sign this form when you begin the program or within 3 days of being hired, and at the time an injury occurs. Please indicate at which point this acknowledgment was completed.

Initiating the network program (companywide)

Initial employee notification (new hire)

Injury notification (Date of injury: / / )

Keep this completed form in the employee's personnel file. It could be requested by Texas Mutual.

Smith Construction Services

Background Check Consent and Release Waiver

National Background Screening Consent Form

Applicant's Legal Name (printed)

Social Security Number

Date of Birth

Applicant's Address

City

State

Zip

I,		, authorize and give consent to
Smith Construction Services to obtain information regarding myself.

This includes the following:

Local & National Criminal background records/information

All 50 State Sex Offender Registries

Full Address Trace

Social Security Verification

I, the undersigned, authorize this information to be obtained either in writing or via telephone in connection with my application. Any person, firm or organization providing information or records in accordance with this authorization is released from any and all claims of liability for compliance. Such information will be held in confidence in accordance with Smith Construction Services guidelines.

By signing this document, I am providing Smith construction Services my consent for an initial background check as well as any subsequent background checks deemed necessary throughout the length of my volunteer/employment assignment with this Organization.

Print Name:

Date:

Signature:

Employee Agreement And Consent To Drug And/Or Alcohol Testing

I hereby agree, upon a request made under a drug/alcohol testing policy of Smith construction services, to submit to a drug or alcohol test and to furnish a sample of my urine, breath, hair, and/or blood for analysis. I understand and agree that if I at any time refuse to submit to a drug or alcohol test under company policy, or if I fail to cooperate with the testing procedures, I will be subject to immediate termination. I further authorize and give my full permission to have the company and or its company physician send my specimen/specimens to a laboratory for a screening test for any of the prohibited substance under the policy. And for the laboratory or other testing facilities to release any and all documentation relating to such test to the company and any government entity involved in a legal proceeding or investigation connected with the test.

I will hold harmless the company, its company physician and any testing laboratory the company might use, meaning that I will not sue or hold responsible such parties for any alleged harm to me that might result in such testing, including loss of employment or any other kind of adverse job action that might arise as a result of the drug and alcohol test. Even if the company laboratory representative makes an error in the administration or analysis of the test or the reporting of the results. I will further hold harmless the company its company physician and any laboratory the company might use for and alleged harm to me that might result from the release or use of the information is within the scope of this policy and the procedures as explained in the paragraph above.

I UNDERSTAND THAT THE COMPANY WILL REQUIRE A DRUG TEST UNDER THIS POLICY WHENEVER I AM INVOLVED IN AN ON THE JOB ACCIDENT OR INJURY UNDER CIRCUMSTANCES THAT SUGGEST POSSIBLE INVOLVEMENT OR INFLUENCE OF DRUGS OR ALCHOL ON THE ACCIDENT OF INJURY.


Signature Of Employee	Date

Employees Name - Printed