DECONSTRUCTIONIST APPLICATION FORM

Instructions: This application must be completed entirely and signed. Please print legibly and read and sign on the last page. A resume and cover letter may be attached to this application, but will not substitute for completion of this form. Also please complete the Additional Application Questions. Let us know if you need any assistance or accommodation in the application or interview process.

GENERAL INFORMATION (Please print clearly!)

Your full name__________________________________________________________________
Home phone_____________________________

Message phone___________________________
Address________________________________________________________________________

Street

___________________________________________________________

City State Zip Code

E-Mail______________________________________________
If hired, can you provide proof that you are authorized to work in the United States? Yes______ No________

Date you are available to work_____________________________

Have you worked here before? Yes______ No______.
If yes, when?____________________________________________

If relevant to the job you are applying for, do you have a current valid driver’s license? Yes____ No____

As an adult, have you been convicted of a crime other than minor traffic offenses? Yes___ No___
If yes, please explain. Convictions are evaluated for each position and do not necessarily disqualify you.________________________________________________________________

____________________________________________________________________
____________________________________________________

Referred by: Employee______ Newspaper______ Our Website______ State Employment Dept _______
Job Fair_______ Local Job Posting _______
Other (please specify)___________________________________________________

WORK HISTORY. Begin with your most recent work experience and list all periods of employment for the last 10 years. Include volunteer, self-employment, U.S. military service and periods of unemployment in your work history.

1. Employer’s Name_________________________________________________________
Dates of Employment. From______________________ To_______________________

Address____________________________________________________________________________________

Phone___________________________
Name & Title of Supervisor________________________________________________________________

Your Title_____________________________________________ Full Time____ Part Time____
Ending hourly or annual pay________________

Your Duties_________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
________________________________________________________________________________________

Reason for Leaving______________________________________________________________
May We Contact This Employer? Yes____No____

2. Employer’s Name_________________________________________________________ Dates of Employment. From______________________

Address____________________________________________________________________________________ To_______________________

Phone___________________________ Name & Title of Supervisor________________________________________________________________

Your Title_____________________________________________ Full Time____ Part Time____ Ending hourly or annual pay________________

Your Duties______________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Reason for Leaving______________________________________________________________ May We Contact This Employer? Yes____No____

3. Employer’s Name_________________________________________________________ Dates of Employment. From______________________

Address____________________________________________________________________________________ To_______________________

Phone___________________________ Name & Title of Supervisor________________________________________________________________

Your Title_____________________________________________ Full Time____ Part Time____ Ending hourly or annual pay________________

Your Duties______________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Reason for Leaving______________________________________________________________ May We Contact This Employer? Yes____No____

4. Employer’s Name_________________________________________________________ Dates of Employment. From______________________

Address____________________________________________________________________________________ To_______________________

Phone___________________________ Name & Title of Supervisor________________________________________________________________

Your Title_____________________________________________ Full Time____ Part Time____ Ending hourly or annual pay________________

Your Duties______________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Reason for Leaving______________________________________________________________ May We Contact This Employer? Yes____No____

5. Employer’s Name_________________________________________________________ Dates of Employment. From______________________

Address____________________________________________________________________________________ To_______________________

Phone___________________________ Name & Title of Supervisor________________________________________________________________

Your Title_____________________________________________ Full Time____ Part Time____ Ending hourly or annual pay________________

Your Duties______________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Reason for Leaving______________________________________________________________ May We Contact This Employer? Yes____No____

EDUCATION AND TRAINING

School Name Years Completed Degree/Certificate (include major)

High School_____________________________________________________________________________________________________________

College ______________________________________________________________________________________________________________

Trade School_____________________________________________________________________________________________________________

Other___________________________________________________________________________________________________________________

List specialized work-related computer skills, training, apprenticeships, or other qualifications you have____________________________________

________________________________________________________________________________________________________________________

DECONSTRUCTIONIST POSITION: Additional Application Questions

ATTENTION: We are not concerned with exact spelling or punctuation. Just make sure that your writing is neat and your sentences are clear. We are only reviewing the content of your responses. Should you need additional space for your response, please feel free to use the reverse side of this sheet or additional paper. THANK YOU!!!

1. The position you are applying for is DeConstructionist. The position may provide up to 40 work hours per week - generally a 7 am to 3:30 pm schedule – although there is no guarantee of hours. This is an hourly position, based on experience. Full medical and dental benefits are available after 90 days of employment. Would these conditions work for you?

YES _____ NO _____

Please comment:_________________________________________________________________________________________________________________________________________________________

2. Each year our organization saves over 4.5 million pounds of used building and remodeling materials from going to the dump. The ReBuilding Center accomplishes this by accepting donations of used building and remodeling materials from all over the region and selling them to the public for reuse. The DeConstruction Services staff is responsible for safely and efficiently hand-deconstructing building structures, maximizing reuse of materials. The work is physically demanding and you must enjoy working outside in all weather conditions. The results are of great benefit to the local community and our environment. Why would you be interested in doing this kind of work and why would you be good at it?

Comments:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________________________________

3. Our organization puts a high value on treating all people with respect and dignity and maintaining a positive attitude in the workplace. It is our desire to hire people who can contribute to this goal. Do you see yourself as someone who will contribute to and support this type of work environment?

YES _____ NO ______ MAYBE _______
______________________________________________________________
Thank you for applying with The ReBuilding Center.

PLEASE READ THE FOLLOWING STATEMENTS AND INITIAL BEFORE SIGNING THIS APPLICATION

Our United Villages is an equal opportunity employer and does not discriminate on the basis of gender, age, race and color, religion, marital status, national origin, sexual orientation, disability or veteran status. (____ initial here)

Interviews are given on a competitive basis, using job-related factors, after a written application has been received and reviewed. Not everyone who applies for a vacant position will be interviewed. (____ initial here)

I understand that, if selected, I will be required to provide proof of my identity and my legal right to work in the United States prior to actual employment with Our United Villages (____ initial here)

I understand that, if selected and if appropriate to the position, I will be required to pass a pre-employment physical as a condition of employment (____ initial here).

I consent to drug testing as may be requested by Our United Villages (____ initial here)

I certify that I have answered truthfully and have not knowingly withheld any information relative to my application. I understand that a misrepresentation or material omission on this application will result in my being eliminated from further consideration. I further understand that, if accepted for employment, any misrepresentation or material omission that becomes known to Our United Villages., will result in immediate termination of my employment. (____ initial here)

I authorize all previous employers and supervisors, including all persons with and for whom I have worked, to give Our United Villages’ representatives all information regarding me and my previous employment. I release Our United Villages, and all previous employers and supervisors from liability for any damages that may result from furnishing information to Our United Villages (____ initial here)

In consideration of my employment, I agree to conform to the instructions, rules and policies of Our United Villages. I understand Our United Villages is an employer at will and my employment and compensation can be terminated at any time, with or without cause and with or without notice, at the option of either the company or myself. (____ initial here)

Your Signature _________________________________________________________

Date_______________________

Thank you for your interest in Our United Villages