EMPLOYMENT APPLICATION Jeremy Jensen | Phone: (605) 990-4800 | Email: jeremy@jensendesignbuild.com PERSONAL INFORMATION Name * First Name Last Name Subject * Enter your LAST NAME and then APPLICATION SSIN# * Phone * (###) ### #### Email * Are you 18 or older? * Yes No Date of Birth: * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Are you entitled to work in the United States? * Yes No Have you been convicted of a felony or been incarcerated in connection with a felony in the past seven years? * Yes No If you answered YES to the previous question, please explain: Military Service? * Yes, I have served. No, I haven't served. If you answered YES to the previous question, please write down which branch: Which position are you applying for? * How did you hear about this position? * Expected Hourly Rate: * $ Expected Yearly Earnings: * $ Date Available: * MM DD YYYY PRIOR WORK EXPERIENCE (1) Current or Most Recent Employer - Current or Most Recent * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Name of Immediate Supervisor: * Dates of Employment: * Position/Job Title * Pay: * $ Reason for Leaving: * (2) Prior Employer - Prior Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Name of Immediate Supervisor: Dates of Employment: Position/Job Title Pay: $ Reason for Leaving: (3) Prior Employer - Prior Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Name of Immediate Supervisor: Dates of Employment: Position/Job Title Pay: $ Reason for Leaving: PRIOR CONSTRUCTION EXPERIENCE Prior Framing Experience * Prior Trimwork & Finish Experience * Other Construction Experience * EDUCATION High School Name/Location: * Last Year Complete: * 9 10 11 12 Degree: * College/University Name/Location: * Last Year Complete: * 1 2 3 4 Degree: * Major or Emphasis: Trade School Name/Location: * Last Year Complete: Degree: * Major or Emphasis: REFERENCES Reference 1 Name - Reference 1 * First Name Last Name Relationship * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Reference 2 Name - Reference 2 * First Name Last Name Relationship * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Reference 3 Name - Reference 3 * First Name Last Name Relationship * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### OTHER Please list other information on yourself or your prior experience you would like us to consider. SIGNATURE BY TYPING MY NAME BELOW, I UNDERSTAND AND AGREE THAT I AM DIGITALLY SIGNING THIS DOCUMENT. * Please type your FULL first and last name below. Date of Submission: * MM DD YYYY Thank you!
