APPLICATION FOR EMPLOYMENT

WICKER CONSTRUCTION IS AN EQUAL OPPORTUNITY EMPLOYER.  All practices of recruiting, hiring, promotion, transfer, wage and salary administration, benefits and terminations are administered without regard to race, color, creed, sex, religion, national origin, disability, age, veteran status or any and all other unlawful biases regarding federal, state or local laws.  Further, we are committed to providing a work environment that prohibits, in any form, unlawful harassment.  To be considered for employment, all applicants must fill out this form completely. (“See resume” is not an appropriate response).   This application will be considered, but its receipt does not imply that the applicant will be employed by the company.  This form becomes a part of your permanent employment record if you are hired. 

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION (Please Print Full Legal Name)

List all addresses for the last 7 years:

TYPE OF WORK DESIRED

GENERAL INFORMATION

SECURITY DATA

Pursuant to the OIG Compliance Program, Employees convicted of criminal offenses or offenses including fraud and abuse related to health care are prohibited from participating in any portion of the direct or indirect health care delivery process. In the event of any pending charges, current employees may be removed from direct responsibility including patient care or involvement with any Federal health care program.

EDUCATION AND TRAINING

ACADEMIC ACHIEVEMENTS AND ACTIVITIES:

Please list academic honors, scholarships, or fellowships; memberships in academic honorary societies; or participation in or offices held in extracurricular activities you consider significant. (You may exclude all information of age, sex, race, religion, color, national origin and handicap.)

EMPLOYMENT HISTORY

Please list your employment history for the past 15 years or your last five employers. Start with your current employer. Include U.S. Military Service.

REFERENCES

List three (3) Business Professional Reference of those who have worked with you. If this is your first job, please list i.e.  Teachers, Pastors, Professors that know you. 
 Do not list anyone related to you.


READ CAREFULLY BEFORE SIGNING THE APPLICATION FOR EMPLOYMENT:


If employed by Wicker Construction and in consideration thereof, I understand and agree to:

  1. I certify that the answers given by me to the forgoing questions and statements on the employment application and or during the employment interview process are true and correct without any consequential omissions of any kind whatsoever.  I understand that any misleading or incorrect statements may render this application void and, if employed, would be case for my termination.  I further agree that Wicker Construction shall not be liable in any respect if my employment is terminated because of falsity of statements, answers or omissions made by me in this application.
  2. I authorize the companies’ schools, persons or entities given during the employment process or on this employment application as references or past employers or affiliations to give any information regarding my employment, character, qualifications, certifications and licenses and hereby release said companies, schools, persons or entities from all liability for any damage for issuing this information.
  3. I understand that I may be required to have a medical examination and/or drug and alcohol test after an offer of employment has been made and prior to the commencement of my employment duties.  A favorable result on the medical examination and/or drug and alcohol test would be a condition of my employment or commencement of any employment duties.
  4. I understand that my employment is not for a specified or definite term and that I may resign, or I may be discharged, at any time with or without prior notice.  I further understand that this policy cannot be changed or amended except by written agreement signed by me and by a corporate officer.
  5. My employment shall be in accordance with the terms of this application, all safety and incident reporting rules, all health care industry compliance program requirements and all other Wicker Construction rules, regulations, policies and procedures currently or hereafter in effect.
  6. I certify that as a part of the application process, I have been provided with a written job description or have had the opportunity to review and/or discuss the requirements for the available position.  I understand each requirement and certify that I am capable of meeting each and every requirement.  I also understand if the position for which I am applying requires licenses and/or certifications, it is my responsibility and a requirement for continued employment to maintain valid licenses and/or certifications.
  7. If hired, employment will be at-will, meaning Wicker Construction can terminate the employment at any time, with or without cause or notice, for any lawful reason.