Chapman Employment Application

Employment Application

84 Winchester Street
Newton, MA 02461
617.630.8408 phone
617.630.8409 fax
www.chap-con.com

Applicant Information

first name:
middle initial:
last name:
street address:
city:
state:
zip:
phone:
e-mail address:
date available:
position applied for:
special skills:
hobbies/interests:
Are you a U.S. citizen?		yes no
If no, are you authorized to work in the U.S.?		yes no
Have you ever been convicted of a felony?		yes no
If yes, please explain:

Education

high school:
address:
date from:
date to:
did you graduate?		yes no

college:
address:
date from:
date to:
did you graduate?		yes no
degree:

other institution:
address:
date from:
date to:
did you graduate?		yes no
degree:

References

Please list three professional references:

Reference #1
full name:
company:
address:
relationship:
phone:

Reference #2
full name:
company:
address:
relationship:
phone:

Reference #3
full name:
company:
address:
relationship:
phone:

Previous Employment

Employer #1
company:
address:
city:
state:
zip:
telephone:
supervisor:
starting salary:
ending salary:
responsibilities:
starting date:
ending date:
reason for leaving:
May we contact your supervisor for a reference?		yes no

Employer #2
company:
address:
city:
state:
zip:
telephone:
supervisor:
starting salary:
ending salary:
responsibilities:
starting date:
ending date:
reason for leaving:
May we contact your supervisor for a reference?		yes no

Employer #3
company:
address:
city:
state:
zip:
telephone:
supervisor:
starting salary:
ending salary:
responsibilities:
starting date:
ending date:
reason for leaving:
May we contact your supervisor for a reference?		yes no

Military Service

branch:
date from:
date to:
rank at discharge:
type of discharge:
If other than honorable, please explain:

Disclaimer and Signature

By clicking the submit button below, I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

As a condition of employment, applicants for employment are required to pass a physical examination concerning their mental and physical fitness to perform safely and efficiently the jobs for which they have applied. This examination includes drug and/or alcohol screening. The examination is administered by a physician designated by the company. Each newly-hired applicant will complete a three-month orientation period during which the new employee's supervisor will evaluate the employee's work performance. The completion of the orientation period does not guarantee employment for any period of time thereafter.

Chapman Construction/Design is a non-smoking company. To help protect and enhance our indoor air quality and to contribute to the health and well-being of all employees, tenants and visitors, smoking is not allowed in the building or within 25 feet of the building (LEED Indoor Environmental Quality Prerequisite 2). On every project site, smoking is only allowed in designated areas.

type full name:

date: