Piece Work Application

Personal Information
Name *
First Last
Phone Number *
### - ### - ####
To what areas can you travel? (Check all that apply)
Los Angeles
County
San Bernadino
County
Orange County
San Diego
County
Are you eligible to work in the United States? *
Yes
No
Do you have your own truck and tools? *
Yes
No
If yes, please explain:

 

AVAILABILITY:
Days Available *
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Any
Hours Available *
AM
PM
Graveyard
For specific Day/Hour availability, please enter information below.

 
What date are you available to start work?
 *
MM / DD / YYYY

EMPLOYMENT HISTORY:

Present Or Last Position:
Employer: *
Address: *
Supervisor: *
Phone Number *
### - ### - ####
Email
Position Title: *
Start Date *
MM / DD / YYYY
End Date *
MM / DD / YYYY
Responsibilities: *

 
Salary *
Input hourly wage, if not salaried.
Reason for Leaving: *

 
May We Contact Your Present Employer? *
Yes
No
References:
Name/Title Address Phone *
I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for
immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.
Do you agree with the terms and conditions? *
Yes, I
agree.
Initial *
Date *
MM / DD / YYYY
Image Verification
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