           This is an application for employment. In order to be employed by Gallagher Masonry you must fill
        out this application and must have the following:

                            1) A valid drivers license
                            2) A reliable means of transportation
                            3) A current drug free card

           If you have these things you can print out and complete this application then fax it to 330-825-4878.
        Or you can mail it to 3144 Whipple Dr. Suite 101 Norton, OH 44203.

Application for Employment

Personal Information Date__________________________

Name________________________________________ Social Security #______________________________

Present Address______________________________ City___________________________ State ______________ Zip ___________

Phone #_____________________________________ Referred by ______________________________________________________

Position desired_____________________________________________ Date you can start __________________________________

Present employer_________________________ ____ Can we contact your past & present employers? __ __Yes No

Have you applied with our company before? ___________________________ When? _____________________________________

Do you have a valid Driver’s License? _______________________________ Do you have a CDL? ___________ Class___________

Do you have a vehicle to drive to work? _____________ May we check your driving record? Yes No

What Union do you belong to? Are your dues up to date? Yes No

Do you have any cards? (Drug free card, scaffold card, 10 hour OSHA card, safety cards, operators license, etc.)

If yes please describe: _________________________________________________________________________________________

___________________________________________________________________________________________________________

Education History

Name & Location of School Years attended did you graduate? Subject

High School __________________________________________________ ____________ ___________ ___________

College ______________________________________________________ ____________ ___________ ___________

Trade, Business, or Correspondence School _________________________ ____________ ___________ ___________

General Information

How long have you been in this trade? _______________ What is the longest you have worked for one employer? _______________

Special experience/training or skills_______________________________________________________________________________

________________________________________________________________________________________________

Former Employers (list below the last 3 employers, starting with the most recent)

Dates Employer name & address Phone # Reason for leaving

__________ __________________________________________ __________________ __________________

__________ __________________________________________ __________________ _________________

References (Give the names of 3 persons not related to you, whom you have known at least one year)

Name City & Phone # Business

____________________________ __________________________ _________________________

Authorization

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified information on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

Date_____________________________ Signature ____________________________________________