Job Application Form

    Please note, fields marked with a * are required.

    Part 1 - Documents

    If you have a resume, use this link to upload it. (Microsoft Word, Plain Text, and PDF Accepted)

    If you have a cover letter, use this link to upload it. (Microsoft Word, Plain Text, and PDF Accepted)

    Part 2 - Identification

    First Name *

    Last Name *

    Address *


    City *

    State *

    Zip Code *

    Phone Number *

    Your Email

    What position are you applying for? *

    Desired Salary*

    Driver’s License Number if relevant to job

    State

    Expiration Date

    Part 3 - Qualifications

    How many years of related experience do you have?*

    How were you referred to us?

    If you are under 18, can you provide a work permit?*
    YesNoNot Applicable
    If no, please explain

    Have you ever applied to Concrete Protection & Restoration Inc. before?*
    YesNo

    Have you ever worked for Concrete Protection & Restoration Inc. before?*
    YesNo
    If yes, when?

    When can you start?

    Can you perform the essential functions of the job with or without reasonable accommodation?*
    YesNo

    Are you a citizen of the United States?*
    YesNo
    If not, are you legally allowed to work in the United States?*
    YesNoNot Applicable

    Type of employment desired?*
    Full TimePart TimeSeasonal

    Have you ever pleaded guilty, no contest, or been convicted of a crime?*
    YesNo
    If yes, please give details.

    Answering yes to these question does not constitute an automatic rejection for employment. Date of offense, seriousness, and nature of the violation, rehabilitation, and position applied for will be considered.

    Summarize your special skills or qualifications (please fill out if you did not upload a resume)

    Part 4 - Job History

    (begin with most recent position)*

    Previous Employment

    Dates of Employment*

    Positions Held*

    Company Name*

    Address*

    City*

    State*

    Zip*

    Phone*

    Supervisor*

    Supervisor's Title*

    Responsibilities*

    Starting Salary and Title*

    Ending Salary and Title*

    Reason for Leaving*

    May we contact this employer for a reference?*
    YesNo

    Previous Employment

    Dates of Employment

    Positions Held

    Company Name

    Address

    City

    State

    Zip

    Phone

    Supervisor

    Supervisor's Title

    Responsibilities

    Starting Salary and Title

    Ending Salary and Title

    Reason for Leaving

    May we contact this employer for a reference?
    YesNo

    Previous Employment

    Dates of Employment

    Positions Held

    Company Name

    Address

    City

    State

    Zip

    Phone

    Supervisor

    Supervisor's Title

    Responsibilities

    Starting Salary and Title

    Ending Salary and Title

    Reason for Leaving

    May we contact this employer for a reference?
    YesNo

    Part 5 - Signature

    I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial, and other related matters as may be necessary for an employment decision. I hereby release employers, schools, or individuals from all liability when responding to inquiries in connection with my application.
    In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

    Name*

    Date*

     

    Having trouble submitting this form? You may print the form, and fax it to 410-298-4086, or scan and email it to info@concretecpr.com.