Employment Application – Briner Building

Name(Required)

First Middle Last

Middle initial required

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Name of Parent of Guardian

(Applicant must be 18 years of age or older)

Address of Parent of Guardian

Street Address City State / Province / Region ZIP / Postal Code

High School Attended(Required)

Year Graduated

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Military Service

Yes

If yes, type of discharge and year

Are you employed(Required)

Yes

May we contact your current employer?(Required)

Yes

Present Employer

Date of hire

Employer Address

Street Address City State / Province / Region ZIP / Postal Code

Types of duties

List Other Previous Employers

Employer

Employer Address

Street Address City State / Province / Region ZIP / Postal Code

Length of Employment & Duties

Reason for Leaving

May we contact this employer for references?

Yes

References

Name(Required)

First Last

Phone(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Name

First Last

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Have you ever been injured on the job?(Required)

Yes

If yes, please list the type of injuries and how long you were off work

List any construction experience you have and/or tool used in this area

Please Read and Initial Each Paragraph, then Sign Below

I permit Briner Building, Inc. to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release Briner Building, Inc., my former employers and all other persons, corporations, partnerships, and associations from any and all claims, demands or liabilities arising out of or in any way related to such examination or revelation.(Required)

I understand that employment with Briner Building is “at will”, meaning either Briner Building, Inc. or I can end the employment relationship at any time for any reason or no reason at all, and that Briner Building, Inc. can change the terms of my employment at any time without notice.(Required)

I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true and correct to the best of my knowledge and ability. I understand that omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application, or if I am employed by Briner Building, Inc., terms for my immediate expulsion from the company.(Required)