Do  you have a driver's license? Yes No

Driver's License Number
State 

Have you ever been convicted of a crime? 
Yes No
If yes, please explain:

Position Applying For 
Salary Required           

How were you referred to Fitzgerald Painting, Inc.?

Education

High School

Graduated       Yes No

Technical School 

Graduated       Yes No

College  

Graduated       Yes No

Previous Employment

List your current or most recent employment first.  Include work related internships, military and volunteer work.

Skill Assessment

Are you presently working? 
Yes No

Have you had much spray experience?  
Yes No

Can you reglaze windows? 
Yes No

Can you move a 32 foot latter? 
Yes No

Can you tape sheetrock? 
Yes No

Have you ever sanded floors with a floor sander? 
Yes No

Have you ever worked with power sanders?
Yes No
Makita Sanders   Porter Cable DA Sanders

Have you been in a situation when you had to manage people?
Yes No

Do you want to be in a position to manage others?
Yes No

What do you like to do the most in the painting field?


What is your strongest asset as a painter?


What is your least favorite task in the painting field?


What do you like to do when you are not working?


How long does it take you to paint a window 6 over 6?


How long does it take you to paint a window 12 over 12?


How long does it take you to reglaze an average 6 over 6 window?

How much square footage of siding can you paint in a hour?


What would you like to know more about in the painting field?

What do you see yourself doing in 3 years?


What can you contribute to Fitzgerald Painting, Inc.?

Employee compensation is based on
Product knowledge
Technical knowledge
Productivity
Willingness and capability to manage others

Wage increases are based upon the increase in knowledge, productivity or the ability to manage others.  What are you going to do to work toward pay increase?

Release Authorization

I. In connection with my application for employment, I understand that an investigative consumer report may be requested that will include information as to my character, work habits, performance, and experience, along with reason for termination of past employment.  I understand that as directed by company policy and consistent with the job described, you may be requesting information from public and private sources about my workers compensation injuries, driving record, court record, education, credentials, credit and references.

II. Medical and worker's compensation information will only be requested in compliance with the Federal Americans with Disabilities Act (ADA) and / or any other applicable state laws.  According to the Fair Credit Reporting Act, I am entitled to know if employment is denied because of information obtained by my prospective employer from a consumer reporting agency.  If so, I will be notified and given the name and address of the agency or the source which provided the information.

III.  I acknowledge that a telephonic facsimile (FAX) or photographic copy shall be as valid as the original.  This release is valid for most federal, state and country agencies, including the Minnesota Department of Labor.

IV.  Minnesota and California applicants only; if you want a copy of the report(s) ordered check this box .  The report(s) will be sent by the reporting agency to you at the address below.

V.  I herby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, reference or insurance company contacted by AVERT, INC. or its agent, to furnish the information described in Section I.

The following information is required by law enforcement agencies and other entities for positive identification purposes when checking public records.  It is confidential and will not be used for any other purposes.  I hereby release the employer and agent and all persons, agencies and entities providing information or reports about me from any and all liability arising out of the request for or release of any of the above mentioned information or reports.

Please provide your full name

First                        Middle                            Last

Please provide other names you have used

Home address

City                                            State
   

Social Security Number

Date of Birth

The following states require Sex and Race
AL, AR, FL, GA, IA, IL, IN, MI, OR, TX, WI
Sex:   M F
Race:

Driver's License Number                    State
  

Name as it appears on license

Typing your name here is as valid as your
Signature