BLOCK 32 LLC
Application for Employment
We are an equal opportunity employer

Complete the Application for Employment. Use the tab key or your mouse to navigate and fill in all applicable fields. Once complete, please click the "Submit Application" button at the bottom of the page. You may also attach a resume or provide additional information in an email.

Please complete information below.
Name
Present Address  

   

City, State, ZIP 
Telephone #
Email Address
Permanent Address     

   

City, State, ZIP 
Date of Birth

The age Discrimination in Employment Act of 1967 prohibits discrimination on the
basis of age with respect to individuals who are at least 40 but less than 70 years of age.
Required if under the age of 18.
Type of work applying for
Wage desired
Shift willing to work 1 2 (check either one or both)
Are you employed now? YES   NO   
Employer name
May we inquire of your present employer? YES   NO   
Have you applied here before? NO     YES    When?    
Were you ever employed by us before? NO     YES    When?    
SCHOOL RECORD

Type of School

 Name & Location of School Course of Study No. of Years Attended

Did you Graduate?

 Degree
Elementary

YES
NO
High School YES
NO
College/University YES
NO
Trade/Business YES
NO

Subjects of Special Study or Research Work   

EMPLOYMENT RECORD   List last four employers starting with present or most recent first.

Name of Company
Telephone Number

 City,
State		 Nature of Work Wages

From

 To Name of Supvisors Reason for Leaving

PERSONAL REFERENCES

Name

 Address Telephone Business Years
Aquainted

Have you been convicted of a felony or misdemeanor?
NO YES, Please explain

A CONVICTION WILL NOT NECESSARILY DISQUALIFY APPLICANT FROM THE APPLIED POSITION.

Are you aware of any reason you cannot perform the essential functions of the job for which you are applying?
If yes, please explain
MILITARY SERVICE
Have you ever served in the United States Armed Forces?  YES     NO RANK:
Special training you received
Present member of the National Guard or Reserves?

  1. As an equal opportunity employer, BLOCK 32 LLC. abides by applicable non-discrimination laws and will not unlawfully discriminate against any employee or applicant for employment because of race, color, age, sex, religion, national origin, ancestry, Vietnam era veteran status, or disability.
  2. I certify that my answers made to the questions above are true, complete, and correct to the best of my knowledge. I understand that my falsification contained in this information shall be considered sufficient cause for rejection of this application and/or discharge.
  3. Just as I am free to resign at any time, the Company reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no supervisor or representative of the Company, except the President, has any authority to make any agreements to the contrary.
  4. If requested, I will furnish a doctor's statement regarding any condition which I have listed on this questionnaire.
  5. Any job offer is contingent on the findings of a pre-employment physical and drug screening.
  6. I authorize the persons, schools, current and past employers and organizations named in this application (and accompanying resume, if any) to provide BLOCK 32 LLC with any and all information concerning my previous employment and any information they may have, personal or otherwise, and I release all such parties from all liability for any damage or claim that may result from furnishing such information to BLOCK 32 LLC.

BLOCK 32 LLC is a DRUG FREE workplace.

Date available to begin work  
What source were you referred for a position here? 
Social Security #


In lieu of signature, type full name in all CAPS:

By clicking "Submit Form", I hereby electronically consent to and authorize my electronic signature to the employment application.