Job Application – Brimus MB L.L.C

Full Legal Name:*

Position you are applying for?*

Date of Birth:*

day

/

month

/

year

Your Phone Number:*

Area Code

–

Phone Number

Street Address and # – NO PO BOX*

City:*

Zip:*

State*

Which shifts are you willing to accept?*

Day

Evening

Weekends

Are you willing to travel?*

Yes

No

Are you looking for Full Time or Part Time?*

FT

PT

Please note that under the Immigration Reform and Control Act of 1986, that you may be required to fill out a certification verifying that you are eligible to be employed and verifying your identity. You may also be will be required to provide documentation that you should you be employed.

Are you Legally Eligible for Employment in the United States?*

Yes

No

Have you ever been convicted of any violation of law, including moving traffic violations? *

Yes

No

If YES, please provide More details Bellow, If NO, just write N/A*

Do you agree and allow us to run a Criminal Record?*

Yes

No

Date Available for work?*

Are you OSHA Certified?*

What other License or Certifications you possess?*

What is your minimum expectation per hour of pay for this role?*

Who Recommended you to us? Please write the name and the phone number of the person.*

Closest one of your Relatives: Brother, Sister, Parents Full Name, Address and Phone;*

Please download this two forms, print/fill out, sign and send to our office address bellow.

I-9 FORM and W-4 (2020)

Upload Photo of Your ID:*

Upload Photo of Your SS Card:*

Job Application Certification:

I hereby certify that all entries on this job application and any attachments are true and complete. I also agree and understand that any falsification this information may result in my forfeiture of employment. I understand that all information on this job application is subject to verification and I consent to criminal history and background checks. I also agree that you may contact references and educational institutions listed on this application.

I will inform you as well two weeks in advance if leaving your company.

I AGREE. *

First

Last

Date*

Your E-mail:*

Word Verification

BRIMUS MB L.L.C.

General Construction Company

1004 Dudley Ave | Utica, NY | 13501

Tel. (315) 735-9158 / Fax (315) 735-4101