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Application For Employment

Last Name

First Name

Middle Initial

Address

City

State

Zip

Telephone Number

Email Address

Social Security Number

Position Applied For

Date of Application

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NICHOLAS INSULATION SERVICES, INC. is an Equal Opportunity Employer and participates in the E-Verify Program, as per Alabama State Law. All applicants will be considered without regard to race, color, sex, religion, age, national origin, marital status, handicap or status as a disabled veteran of the Vietnam Era.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this period should inquire as to whether applications are being accepted at that time.

When can you report for work

Are you 18 years of age or older

If related to anyone in our employ, state name and position

Have you ever worked for us before?

If so, when

Position

Supervisor

Have you ever been discharged, reprimanded or asked to resign from any previous place of employment?

If so, please explain

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied?

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As your potential employer, we reserve the right to ensure you are physically capable of performing duties associated with the position you are applying for.

Have you been convicted of a crime (excluding misdemeanors and traffic violations) in the past ten years?

If so, please explain

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Person to be notified in case of emergency

Name

Address

Phone

Relationship

Referral Source:

Trade, Business or Special Skills

Do you have tools of your trade

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RECORD OF PAST EMPLOYMENT

(List last Position First)

Employer

City, State

Job Title

Supervisor

Date Employed (From)

Date Employed (To)

Rate of Pay (Starting)

Rate of Pay (Final)

Work Performed

Reason for Leaving

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Employer

City, State

Job Title

Supervisor

Date Employed (From)

Date Employed (To)

Rate of Pay (Starting)

Rate of Pay (Final)

Work Performed

Reason for Leaving

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Employer

City, State

Job Title

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Date Employed (To)

Rate of Pay (Starting)

Rate of Pay (Final)

Work Performed

Reason for Leaving

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I hereby certify that all of the facts and information listed on this employment application are true and complete, to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that any false, incomplete, or misleading information given by me on this application is sufficient cause for rejection of this application, and if employed, will be cause for termination at any time.

If employed, I agree to acquaint myself with and abide by all rules, regulations and company policies that are established or amended by Nicholas Insulation Services, Inc. I understand that the first 90 days of my employment will be a Probationary Period. I further understand and agree that my employment and compensation will be for an indefinite duration and can be terminated, with or without cause and with or without notice at any time, regardless of the successful completion of my probationary period, at the option of either myself or Nicholas Insulation Services, Inc. I understand that no supervisor or representative of Nicholas Insulation Services other that the President has any authority to enter into any agreement for the employment of any specified period of time, or to make any agreement contrary to the foregoing.

Signature of Applicant

Date

Contact Us

Call Nicholas Insulation Services at (251) 471-5900 in Mobile, AL.