FMGI Pre-employment Application "*" indicates required fields Step 1 of 4 25% Current InformationFirst Name*Last Name*Mobile Phone*Home PhoneOffice PhoneEmail* What is best way to contact you?MobileEmailCurrent Address* Street Address Address Line 2 City 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 State ZIP Code Social Security Number*Are you over 18?* Yes No Are you a citizen of the U.S. or do you have the legal right to be employed in the United States?* Yes No Have you ever been convicted of any crime (excluding minor traffic violations) including DWI?* Yes No NOTE: A CONVICTION WILL NOT NECESSARILY DISQUALIFY YOU FROM EMPLOYMENT.State the offense, location, date and disposition.Driver License* 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 State License Number*License TypeIs License Currently Valid* Yes No If you worked in any of your previous positions under another name, please give that name(s).Are you presently employed?* Yes No May we contact your present employer? Yes No Have you ever been fired, or asked to resign from a job?* Yes No Please explain.Are you seeking?* full-time part-time temporary or summer employment Is there are specific position you are applying for?Annual Salary DesiredDate Available to Start MM slash DD slash YYYY Have you ever worked for our company before?* Yes No State when and where you worked.Are you now, or do you expect to be, working in any other business or job?* Yes No Please explain.Do you have any obligations or other reasons, which would limit your ability to travel or work overtime?* Yes No Please explain.Would you be willing and able to relocate?* Yes No Are there any days or hours you would be unable or unwilling to work?* Yes No Please specify those days or hours you would be unable or unwilling to work. Employment HistoryPlease give accurate, complete full-time and part-time employment record. Start with present or most recent employer.Employment Record 1Company NamePhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Employed From MM slash DD slash YYYY Employed To MM slash DD slash YYYY Starting PayEnding PayName of SupervisorYour TitleDescribe Your Roles and ResponsibilitiesReason for LeavingEmployment Record 2Company NamePhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Employed From MM slash DD slash YYYY Employed To MM slash DD slash YYYY Starting PayEnding PayName of SupervisorYour TitleDescribe Your Roles and ResponsibilitiesReason for LeavingEmployment Record 3Company NamePhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Employed From MM slash DD slash YYYY Employed To MM slash DD slash YYYY Starting PayEnding PayName of SupervisorYour TitleDescribe Your Roles and ResponsibilitiesReason for LeavingEmployment Record 4Company NamePhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Employed From MM slash DD slash YYYY Employed To MM slash DD slash YYYY Starting PayEnding PayName of SupervisorYour TitleDescribe Your Roles and ResponsibilitiesReason for LeavingEmployment Record 5Company NamePhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Employed From MM slash DD slash YYYY Employed To MM slash DD slash YYYY Starting PayEnding PayName of SupervisorYour TitleDescribe Your Roles and ResponsibilitiesReason for Leaving EducationHigh SchoolHigh School NameAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Date From MM slash DD slash YYYY Date To MM slash DD slash YYYY Did you graduate? Yes No Courses studiedCollegeCollege NameAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Date From MM slash DD slash YYYY Date To MM slash DD slash YYYY Did you graduate? Yes No Courses studiedTrade SchoolTrade School NameAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Date From MM slash DD slash YYYY Date To MM slash DD slash YYYY Did you graduate? Yes No Courses studiedIf you did not graduate, why did you leave high school or college?Are you planning to pursue further studies? Yes No When, where and what courses?List any scholastic honors, offices held and activities involved in during high school and college.List and describe any other school or specialized training.Service RecordHave you ever served in the military? Yes No Are you a member of a reserve organization? Yes No Service BranchFinal RankDate Entered MM slash DD slash YYYY Date Separated MM slash DD slash YYYY ResponsibilitiesIs there any reason you would be unable or unwilling to perform any of the tasks required by the job you are applying for? Yes No Explain which tasksHave you filed any type of fraudulent claim against any of your present or past employers? Yes No Please explainWill you abide by the safety rules of this company? Yes No Have you ever been disciplined for violating company safety rules or regulations? Yes No Please ExplainHow many days of work (or school) have you missed in the last two years?Please enter a number from 0 to 730.What were the reasons for your absence?How many times have you been late for work (or school) in the last two years?Please enter a number from 0 to 730.What were the reasons for your late arrivals?Is there any reason why you would be unable or unwilling to report to work on time every day on a regular and consistent basis? Yes No Please explain whyDo you have any training in First Aid or CPR? Yes No Which one(s)?Do you have any safety training? Yes No Do you read blueprints? Yes No Do you know how to use a level or transit? Yes No Do you have a powder actuated tool certificate? Yes No Do you have a laser-training certificate? Yes No What concrete forming systems have you used?Do you have any heavy equipment experience? Yes No List equipment typeHave you had any computer or word processing experience or training? Yes No List software and programsWhat languages do you speak fluently?Use this space below to describe why you are interested in working for our company and to list those skills and abilities which you feel particularly qualify you for a position with us.AFFIDAVIT*I certify that my answers to the questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application form or during any interviews may be grounds for my immediate discharge. I hereby authorize the Company to contact any company or individual it deems appropriate to investigate my employment history, character and qualifications and I give my full and complete consent to their revealing any and all information they wish as a result of this investigation. In addition, I hereby waive my right to bring any cause of action against these individuals for defamation, invasion of privacy or any other reason because of their statements. I agree that, if I am employed, I will abide by all the rules and regulations of the company. ALL APPLICANTS MUST SUBMIT TO, AND PASS, AN ALCOHOL AND DRUG TEST AS A CONDITION OF EMPLOYMENT. I understand that the taking of drug and alcohol tests, when given pursuant to company policy, are a condition of continued employment and refusal to take such tests when asked will be grounds for my immediate termination. I further understand that nobody in the Company is authorized to enter into any written or verbal employment contracts with me for any definite period of time without the express written consent of the President of the Company. I also understand that my employment is “at-will” and may be terminated by myself or by the company at any time for any reason or no reason at all, with or without prior notice. Our Company is an equal opportunity employer and will consider all applicants for all positions equally without regard to their race, sex, age, color, religion, national origin, veteran status or any disability, which is not job-related. This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner as no action can be taken on this application until all questions have been answered. I certify the information provided and agree to the statements above.
