Employment Application




Personal Data

Last Name
First Name
Middle Name
Nickname
Current Street Address
City
State
Zip
Current Mailing Address (if different from above)
City
State
Zip
Telephone Work/Day
Telephone Home/Evening
Are you legally authorized to work in the U.S.? (Proof of identity and legal right to work will be required upon employment.)
Yes No
Will you now or in the future require sponsorship for employment status (for example to obtain an H-1B visa)?
Yes No
Have you ever been known by any other name(s)?
Yes No
If yes, please list:
Have you ever worked for Window Warmth, LLC, Jemico, LLC, J&M Windows, Telefluent Communications, Inc. or Renewal by Andersen before?
Yes No
Approximate Date
Reason you are no longer employed by one of the above companies:



Referral Info

How did you hear about employment at Renewal by Andersen?



Work Preference

Type of Position Desired
Salary Requirements
Type of Employment Desired
Full Time
Part Time
Temporary
Intern
Other
Date Available for Work
Work Location/Geographic Preference



Employment History

Please list your job history for the past seven (7) years in chronological order.
(Applicant may include in such history any verified work performed on a temporary, cooperative, summer and/or volunteer work).
Present or Most Recent Employer
Type of Business
Telephone Number
Dates of Employment
From    To
Address (Street Number, City, State and Zip)
Starting Base Salary
$      Per
Job Title
Supervisor Name and Title
Final Base Salary
$      Per
Describe Your Responsibilities
Reason for Leaving
May we contact this company?
Yes No
If no, may we contact upon your acceptance of our employment offer?
Yes No       Contact Name


Previous Employer
Type of Business
Telephone Number
Dates of Employment
From    To
Address (Street Number, City, State and Zip)
Starting Base Salary
$      Per
Job Title
Supervisor Name and Title
Final Base Salary
$      Per
Describe Your Responsibilities
Reason for Leaving
May we contact this company?
Yes No
If no, may we contact upon your acceptance of our employment offer?
Yes No       Contact Name


Previous Employer
Type of Business
Telephone Number
Dates of Employment
From    To
Address (Street Number, City, State and Zip)
Starting Base Salary
$      Per
Job Title
Supervisor Name and Title
Final Base Salary
$      Per
Describe Your Responsibilities
Reason for Leaving
May we contact this company?
Yes No
If no, may we contact upon your acceptance of our employment offer?
Yes No       Contact Name


Previous Employer (including address) Dates of Employment Telephone Number Reason for Leaving
From To
Previous Employer (including address) Dates of Employment Telephone Number Reason for Leaving
From To
Previous Employer (including address) Dates of Employment Telephone Number Reason for Leaving
From To
Previous Employer (including address) Dates of Employment Telephone Number Reason for Leaving
From To



Military Experience (Do not include ROTC)

Be sure to include any special/technical training (show dates, names and addresses of schools)
Branch of Service
Dates of Service
From To
Rank at Discharge
Occupational Specialization
Branch of Service
Dates of Service
From To
Rank at Discharge
Occupational Specialization
Branch of Service
Dates of Service
From To
Rank at Discharge
Occupational Specialization
Branch of Service
Dates of Service
From To
Rank at Discharge
Occupational Specialization



References

Please list three persons best qualified to comment on your related experience and/or educational background.
Name
Relationship
Address
Telephone Number
Name
Relationship
Address
Telephone Number
Name
Relationship
Address
Telephone Number



Education

Name and address of high school(s), college(s) or
other schooling (include street, city, state and zip).
Dates of Attendance Years Completed Major Studies/Degree(s)
From To
From To
From To



Scholastic Record (College Only)

Undergraduate cumulative overall grade point average: On a Scale of A = ? Points Rank in Class
Top 10%
1st Qtr.
2nd Qtr.
3rd Qtr.
4th Qtr.
Undergraduate grade point average in major field: On a Scale of A = ? Points
Graduate cumulative overall grade point average: On a Scale of A = ? Points



Activities

List school, campus, professional and/or community activities. Include any office(s) held. (If you wish, you may omit any
organization or activity, the name of which indicates the race, sex, color, religion or national origin of its members.)
Name of Organization/Activity
Role/Position
Duties/Accomplishments
Dates (Include Month and Year)
List licenses, special training or skills you would like considered; e.g., Bi-lingual, Professional Engineer, CPA, programming, etc.



Additional Information

The fact that you are awaiting trial or have a record of conviction will not necessarily bar you from employment.
Have you been convicted of a felony?
Yes No
If yes, please state the date and disposition.
Do you currently use illegal drugs?
Yes No
Have you ever taken money or articles of value from an employer?
Yes No
If yes, please explain.



An Equal Opportunity Employer.

Discrimination against any individual because of race, sex, color, religion, national origin, a disability, or status as a veteran or a disabled veteran is prohibited. The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age. If you believe you have been discriminated against, you may notify the Equal Employment Opportunity Commission, the Federal Communications Commission, the Office of Federal Contract Compliance Programs or other appropriate federal or state agencies.



As An Applicant You Agree To And Understand The Following:

  1. You must provide proof of identity and authorization to work in the U.S. as required by the Immigration Reform and Control Act of 1986.

  2. You will be required to meet the minimum age requirements of applicable laws.

  3. The Company may conduct investigations including verification of prior employment history and education. By signing this application you hereby grant permission to any person, firm, or corporation to release to the Company or its representative any and all information regarding my past work or employment, and my background. I waive any and all claims I might have with respect to the providing of such information.

  4. I certify that the information provided in this Application is accurate. I understand that the withholding of information or the giving of false information on this application will result in a refusal to hire or in disciplinary action up to and including the termination of my employment.

  5. I understand that nothing in this Application or in the Company’s personnel guidelines, handbooks, policies or procedures is intended to create, or does create, an employment contract between the Company and me. I further understand and agree that if I am offered employment by the Company it will be on an at-will basis. This means that either the Company or I may terminate the employment relationship at any time for any reason, with or without cause. I understand and agree that only the Company CEO can enter into an agreement on any other terms and he or she can only do so in writing signed by him or her and the employee in question. Finally, I understand and agree that this constitutes the entire agreement between the Company and me with regard to this subject.

  6. If you have signed an employment agreement, confidentiality agreement or any other document with a prior employer that might restrict your activities if hired by Window Warmth, LLC, Jemico, LLC, J&M Windows, Telefluent Communications, Inc. or Renewal by Andersen, you must disclose this fact before a job offer is made. Failure to disclose such information is grounds for termination of your employment.
I have read and understand the above.



Enter code rba15 to submit the form.