Gulf South Scaffolding Employment Application
Programs, services, and employment are equally available to everyone.
Please fill out the application as completely as possible. Before you click submit make sure the information you entered is correct.
PERSONAL
Last Name	First Name	MI	SSN
Address	City	State	Zip
Phone	Phone 2		Email
DOB	DL#	State
Date Available to Work
Position Applied for
Type of emolyment desired Full Time Part Time Temporary Seasonal
Do you have reliable transportation? yes no
Are you a U.S. Citizen? yes no
If NO, are you legally allowed to work in the United States?  yes no
Have you ever plead "guilty" or "No contest", or been convicted of a crime? yes no
If YES, give details  (Answering "yes" to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and  nature of the violation, rehabilitation, and position applied for will   be considered.)
Scaffold Experience? yes no       # of Years?              Do you have tools?  yes no
Previous Employers (most recent position first)
Employer 1                                                      Employer 2                                                   Employer 3     From   To                From   To               From   To    Company                                                          Company                                                       Company                                                                          Phone                                                              Phone                                                             Phone                                                                       Supervisor                                                        Supervisor                                                        Supervisor                                                                       Starting Salary   Ending Salary                          Starting Salary   Ending Salary                         Starting Salary   Ending Salary                                                           Position                                                             Position                                                           Position                                                                       Reason For Leaving                                           Reason For Leaving                                        Reason For Leaving                               May we contact this employer for a reference?               May we contact this employer for a reference?             May we contact this employer for a reference?    yes no                                                              yes no                                                            yes no
Education
High School Years Completed     Did you graduate? yes no     College/University Years Completed     Degree earned     Other Years Completed     Degree earned
References
Please furnish the names and phone numbers of three people who you are not related and by whom you have not been employed.    Reference 1                                                     Reference  2                                                 Reference 3    Name                          Name                      Name     Phone                         Phone                      Phone
Application Acceptance Terms
I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries on my    personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision.   I hereby release employers, schools or persons from all liability when responding to inquiries in connection with my application. In the event,   that I am employed, I understand that false or misleading information given in my application or interview may result in discharge.   Accept Terms  yes no    Current Date