Commercial Real Estate Services - Interstate Circle Center

Application for Employment

PLEASE COMPLETE ALL SECTIONS, IF NOT APPLICABLE, ENTER N/A.

Personal Information

Last Name:*

First Name:*

Middle Name:

Email:*

Phone Number:*

Alternate Phone:

Street Address:*

City:*

State:*

Zip:*

Previous Address If Less Than Two Years:

Driver License Number:

State Issued:

Expiration Date:

Where did you learn about this position?*

Position Applying For:*

Rate of Pay Expected:*

Date You Can Start Work:*

Are you 18 years of age or older?*

Yes No

What type of employment you are seeking?*

Part Time Full Time

Check the highest education level or equivalent completed.*

Elementary
8 or less

High
9 10 11 12

College/Tech
1 2 3 4

Graduate/Professional
5 6 7 8

Name of College, University, or VO-TECH Attended:*

Are you currently enrolled?

Yes No

If so, what hours are you available?

Diploma/Degree/Course of Study:*

Special Skills, Training, or Qualifications:*

Are you willing to pursue specialized training or continuing education if required?*

Yes No

Are you able to work overtime?*

Yes No

If currently employed, may we contact your employer?*

Yes No

Have you ever been convicted of a felony or misdemeanor?*

Yes No

Conviction will not automatically disqualify you from employment. If yes, please identify the crime for which you were convicted, the date of conviction, and the city/state of the court in which you were convicted:

Hours Available To Work:*

Employment History If background employment records are in any other surname, please show name used:

List entire employment history, starting with your present employer. Please explain in detail any gaps in employment, showing dates and reasons.

Company Name: *

Phone: *

Address: *

Address 2:

City: *

State: *

Zipcode: *

Supervisor's Name: *

Supervisor's Email: *

Job Title: *

Employed From: *

To: *

Last Pay Rate: *

Duties: *

Reason for leaving: *

Additional Employment (+)

References
List two (2) people (no relatives) you have worked with and whom we may contact for a reference if necessary

First Reference

Name:*

Street:*

City:*

State:*

Zip:*

Email Address:*

Second Reference

Name:*

Street:*

City:*

State:*

Zip:*

Email Address:*

Important IMPORTANT – We are glad you are interested in joining U.L. Coleman Company, Ltd. Please read the following statements carefully, initial each statement, sign, and send it in.

The company, in considering my application for employment, may verify the information set forth on this application and obtain additional background information relating to my background. I authorize all persons, schools, companies, corporations, credit bureaus, law enforcement agencies, etc. to supply any information concerning my background.
I have read, understand, and agree to this statement,(please initial here)*

I understand that U.L. Coleman Company, Ltd. has a commitment to maintain an alcohol/drug-free workplace and that U.L. Coleman Company, Ltd. requires a drug screening test as a part of its selection and hiring process. I understand that such drug screening will consist of the testing of a urine sample or other medically recognized test designed to detect traceable amounts of a controlled substance in my body. If any detectable amounts are found in my body, a second test approved by the NIDA will be performed on the same specimen. If the results of the second test are also positive, I will be disqualified from consideration for employment and any offer of employment withdrawn. I understand that consent and satisfactory results do not guarantee that I will be hired. If offered employment, I consent to a physical exam to determine my general health and fitness to perform the duties of the job.
I have read, understand, and agree to this statement,(please initial here)*

I certify that the information on this application is correct and I understand that any misrepresentation or omission of any information will result in my disqualification from consideration for employment or, if employed, my dismissal. I understand that this application is not a contract, offer, or promise of employment and that if hired, any employment agreement is an “At Will” agreement. I will be able to resign at any time for any reason. Likewise, the company can terminate my employment at any time with or without cause. I further understand that no one has the authority to enter into an employment contract with me. I also understand that I am required to abide by all rules and policies of the employer.
I have read, understand, and agree to this statement,(please initial here)*

I understand that this application is good only for one year from today’s date. If I still desire a position with the company after this application expires, it will be my responsibility to fill out a new application and file it with the company.

Application Date: 17-May-12

Signature (Full Name):*

U. L. Coleman Company, Ltd. • U. L. Coleman Properties, Ltd. • Sequoia Construction, L.L.C.
207 Milam Street, Suite C • Shreveport, LA 71101-7226 • p: 318.221.0541 • f: 318.221.0568