Application

Momchilovich Drywall & Paint, LLC.

Read Before Starting Application

Momchilovich Drywall, LLC. is an equal opportunity employer and does 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 accommodation to the application and/or interview process should notify a representative of the organization.



Signature

Date

GENERAL INFORMATION

Name

Social Security Number


Street Address


Telephone Number

City

State

Zip Code

E-Mail Address

Referred By

*All Questions Must Be Answered

*Have you ever been employed by this Company before?

*Are you personally acquainted with anyone identified with this Company?

*Are you able to meet the attendance requirements?

*Are you 18 years of age or older?

*Can you provide evidence of a valid Drivers License if necessary?

*Can you work overtime if necessary?

*Have you ever been convicted of a crime in the last 7 years?

*Date Available to Start Work:

*Salary Desired:

*Shift/Hours Preferred:

*Type of Work Desired:

*Location Preference:

*Are you a United States citizen or do you otherwise have legal authorization to work in the United States, which is not limited to one particular employer?


** proof of authorization to work will be required upon employment

 

EMPLOYMENT RECORD

Starting with present or most recent, list all previous employers. Include self-employment, summer and part-time jobs.


Add Another Employer

Account for all periods of Unemployment for one month or more since you left school until the present time.

Add Unemployment Range

May we contact your present employer?

Were you employed or did you attend school under a different name(s)?

EDUCATION RECORD

Select Each School You Attended

High School

Technical/Business School

College/University

Graduate School

SKILLS

Use the space below to describe your skills and aptitudes that are related to the job for which you are applying. You may include civic and community activities, professional societies in which you participate, and special training or skills, if you believe these to be relevant.

REFERENCES

Give three (3) names and addresses of any business and/or professional references.

(1) Name:  

Address:  

Phone Number:

Title:


(2) Name:  

Address:  

Phone Number:

Title:


(3) Name:  

Address:  

Phone Number:

Title:

AUTHORIZATION AND RELEASE

In accordance with the Fair Credit Reporting Act, Momchilovich Drywall LLC. may obtain a consumer report on all individuals who apply for new employment or current employees for retention or promotion. Upon my written request, I have the right to obtain a disclosure of the nature and scope of the report.

I hereby authorize Momchilovich Drywall, LLC. who is 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



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Date

I certify that the facts set forth in this application are true, correct and complete without mis-representations or omissions of any kind whatsoever. I authorize investigation of the statements I have made herein.

I hereby release from any and all liability representatives of the Company, for their acts performed in connection with evaluating my application, background, credentials and qualifications. I understand that if any of the information on this application form is discovered to be incorrect, false, misleading, now or at a later date, or if there are any misrepresentations or omissions of any kind whatsoever, then the Company may deny me employment or terminate my employment, and I agree that the Company shall not be liable in any respect if it does so.

I also understand that my employment at the Company is contingent upon the satisfactory results of a drug test and it may include a physical examination and an investigation of my work record, driving record and references. I consent to a pre-employment physical examination and such job-related future examinations as may be required by the Company, each of which may include drug screens as required.

I understand that if I am employed, any such employment is not binding on either party for any specific period of time. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, which means that, I will be an Employee-At-Will.

I further understand that if I am employed, no representative of the Company, other than the Owner of Momchilovich Drywall, LLC., has any authority to enter into any agreement for employment for any specified period of time and any such agreement must be in writing and signed by the Owner.

I hereby acknowledge that I have read and fully understand the above statements, and that I seek employment under these conditions. I also acknowledge that all of the representations I have made in this application are true.



Signature

Date

AUTHORIZATION FOR DRUG/ALCOHOL TESTING

Momchilovich Drywall, LLC. (Company), has a vital interest in maintaining safe, healthful and efficient working conditions for its employees and customers. Illegal drugs pose a serious threat to the health and safety of the user and to others. Therefore, all applicants considered for employment at the Company may be required to submit to a drug-screening test after receiving a conditional offer of employment. Employees will be tested when reasonable cause exists to believe an employee may be using or under the influence of drugs or alcohol, and in the other circumstances listed in the Company’s Drug and Alcohol Policy.


Please carefully read the following statements before signing this form:

I hereby give my consent to the Company to which I am applying for employment or by which I am employed, to collect (or contract to collect) blood or urine samples from me to determine the presence or use of alcohol, and/or controlled substances (including, without limitation, cocaine, marijuana, barbiturates, phencyclidine (PCP), amphetamines, opiates and benzodiazepines). Further, I give my consent for the release of the test results and other relevant medical information to the Company management and any physician(s) designated by the Company for determination of my eligibility for employment.


I understand that if the results of the drug test are positive, I will be given an opportunity to discuss the positive result and any reasonable explanation with a Medical Review Officer.


I understand that if a positive result is caused by medications prescribed by an accredited physician for the treatment of a current condition, the Medical Review Officer may verify the circumstances of use with the physician. I hereby authorize my prescribing physician to disclose such information as may be requested, and will execute any additional consent as are necessary to obtain the release.


I understand that if positive test results are caused by drugs that are not part of a currently prescribed medical treatment program, or if I refuse to sign this Authorization or cooperate fully in the specimen collection process, or I switch or adulterate a test sample, I will not be hired, or if an employee, I will be subject to discipline up to and including discharge. If not hired, I will not be eligible to apply for employment within the Company for one year. I understand that if prescribed medication will adversely affect my ability to perform my job, my application may be deferred, or rejected, or, if an employee, my employment may be suspended or terminated, as appropriate. I release and discharge the Company, its Directors, Officers and agents from any claim or liability arising from the tests described above, including the test process and procedures, the analysis and disclosure of the results.




Signature

Date

Name

Social Security Number

Are you under the age of 18?

VOLUNTARY AFFIRMATIVE ACTION INFORMATION

In an effort to implement our record keeping and reporting requirements, we ask that you complete this data survey. Your cooperation is appreciated. Providing this information is strictly voluntary. Failure to provide it will not subject you to discharge or discipline or any other negative personnel action. Information provided will be kept confidential in accordance with applicable regulations.

NAME:  

CHECK ONE:   Male   Female   Non-Binary   N/A  

CHECK ONE OF THE FOLLOWING RACE/ETHNIC GROUPS

N/A
White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Black or African American: A person having origins in any of the black racial groups of Africa.
Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Native Hawaiian or other Pacific Islander: A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
American Indian or Alaskan Native: A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
Two or More Races: – All persons who identify with more than one of the above six races.
I do not wish to disclose

HOW DID YOU HEAR ABOUT MOMCHILOVICH DRYWALL LLC?
CHECK ONE OF THE FOLLOWING

N/A
Walk-In
Employee Referral
Advertisement
Internet
Agency

Voluntary Self-Identification of Veterans

Reasonable Accommodation Notice

If you are a disabled veteran it would assist us if you tell us whether there are accommodations we could make that would enable you to perform the essential functions of the job, including special equipment, changes in the physical layout of the job, changes in the way the job is customarily performed, provision of personal assistance services or other accommodations. This information will assist us in making reasonable accommodations for your disability. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended. The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.

Self-Identification

I am not a veteran. (I did not serve in the military.)
I belong to the following classifications of protected veterans (Choose all that apply):

DISABLED VETERAN
RECENTLY SEPARATED VETERAN
ACTIVE WARTIME OR CAMPAIGN BADGE VETERAN
ARMED FORCES SERVICE MEDAL VETERAN

I am NOT a protected veteran. (I served in the military but do not fall into any veteran categories listed above.)
I choose not to identify my veteran status.


Definitions

This employer is a Government contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:

A “disabled veteran” is one of the following:

•A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or

•A person who was discharged or released from active duty because of a service-connected disability.

A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service.

An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Protected veterans may have additional rights under USERRA—the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor’s Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL.


APPLICATION ADDENDUM

Installers/Service Technicians

I am interested in the following area(s):

Drywall Installer

Drywall Finisher

Painter

All


The company will deduct a $1200 tool deposit, taken in $50 weekly increments from the employee’s paycheck. The deposit is refundable upon return of tools. These weekly deductions will start immediately upon being hired. If employment ends and the individual returns all tools, in good condition, then MD&P will return the full tool deposit to the individual.



I possess the ability to skillfully and safely use basic hand and power tools.



I am able to meet the physical requirements to consistently climb a ladder and work at heights of 8 feet or above with or without reasonable accommodation.



I am able to meet the lifting requirements of up to 75 pounds with or without reasonable accommodation.



I am able to work under conditions that consistently requires me to work in extreme heat and in small/cramped spaces.



Each employee is responsible for his or her commuting (includes vehicle) to all job-sites, as well as meals and incidentals. Employees will not normally be compensated or reimbursed for the time or expense (includes parking tolls) involved in getting themselves or their tools to or from a job-site. Generally, if a project requires an employee to stay overnight, MD&P will add a premium to their hourly wage. The company reserves the right to pre-determine how much premium we will add for each job as there may be (in the company’s judgement) extenuating circumstances involved with any particular job. We will advise employees in advance whether a premium will apply to any particular job.
I am able to travel out of town and stay overnight for a week, on occasion.



I am fluent in the following languages:

English   Spanish   Other  


Technicians Only  – In addition to the basic tools required, I can provide the following tools to further assist me in performing my work assignments.



Applicant Signature

Date

Name