APPLICATION FORM

Prairie Exteriors & Painting LLC
1820 North St,
Prairie Du Sac, Wisconsin 53578
608-370-2528

Prairie Exteriors & Painting LLC is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

APPLICANT INFORMATION

Applicant Name*

First Last

Telephone Number*

Address*

Street Address City State Zip

Email*

EMPLOYMENT POSITION

Position(s) applying for ( full time):*

On what date can you start working if you are hired?*

MM slash DD slash YYYY

Do you have reliable transportation to and from work?*

Salary desired:*

PERSONAL INFORMATION

Have you ever applied to or worked for Prairie Exteriors & Painting LLC before?*

Yes

Do you have any friends, relatives, or acquaintances working for Prairie Exteriors & Painting LLC?*

Yes

You have applied before. Please let us know when?*

You have indicated Yes. Please state name & relationship.*

Are you 18 years of age or older?*

Yes

Will you consent to a mandatory controlled substance test?*

Yes

Are you a U.S. citizen or approved to work in the United States?*

Yes

What document can you provide as proof of citizenship or legal status?*

Have you ever been convicted of a criminal offense (felony or misdemeanor)?*

Yes

You indicated Yes. Please state the nature of the crime(s), when and where convicted and disposition of the case:*

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

JOB SKILLS/QUALIFICATIONS

Please list below the skills and qualifications you possess for the position for which you are applying:

(Note: Prairie Exteriors & Painting LLC complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. )

EDUCATION AND TRAINING

High School - Name and Location:

High School Year Graduated?

High School Degree Earned

College - Name and Location:

College Year Graduated

College Degree Earned

Vocational School / Specialized Training

Year Graduated

Degree Earned

MILITARY

Are you a member of the Armed Services?*

Yes

What branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

PREVIOUS EMPLOYMENT

Employer 1

Employer 1 - Company Name

Employer 1 - Job Title

Employer 1 - Supervisor Name

Employer 1 - Employer Address, City, State, Zip Code

Employer 1 - Telephone

Employer 1 - Dates Employed - From: mm/yyyyy TO mm/yyyyy

Employer 1 - Reason for leaving?

Employer 2

Employer 2 - Company Name

Employer 2 - Job Title

Employer 2 - Supervisor Name

Employer 2 - Employer Address, City, State, Zip Code

Employer 2 - Telephone

Employer 2 - Dates Employed - From: mm/yyyyy TO mm/yyyyy

Employer 2 - Reason for leaving?

REFERENCES

Please provide 3 personal and professional reference(s) below:

Reference Name - 1

Reference 1 - Contact Information

Reference Name - 2

Reference - 2 - Contact Information

Reference Name - 3

Reference - 3 - Contact Information

AT WILL EMPLOYMENT

The relationship between you and the Prairie Exteriors & Painting LLC is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Prairie Exteriors & Painting LLC. No representative of Prairie Exteriors & Painting LLC has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.

Acceptance & Signature*

I agree to the above conditions and to Prairie Exteriors & Painting LLC Privacy Policy

Signature*

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Prairie Exteriors & Painting

Serving the Greater Madison Area