SMITH, BROOMFIELD & HOWARD
CONSTRUCTION AND RESTORATION, LLC

321 WEST ALFRED STREET, TAVARES FL 32778
 
Lamar Smith ...........   lsmith@sbhconstruction.com
Bryan Broomfield .....  bryan@sbhconstruction.com
Shawn Howard  ......   showard@sbhconstruction.com

phone: 352-343-1390     fax: 352-343-3284
        

APPLY ONLINE (Print, fill out and fax or mail in.)

COMPANY OR
EMPLOYER NAME:SMITH, BROOMFIELD & HOWARD CONSTRUCTION AND RESTORATION, LLC                 POSITION APPLIED FOR____________________________________________________________
Employment Application                           APPLICANT TELEPHONE___________________________________________________________
                                                                                                                                               
                                                                                                                                                SOCIAL SECURITY NUMBER________________________________________________________

YOUR NAME___________________________________________________________________________________________________________________________________________________________
                                  LAST                                                                          FIRST                                                                                            MIDDLE

ADDRESS:                                                                                                                     ARE YOU LEGALLY ELEGIBLE FOR EMPLOYMENT IN THE UNITED STATES OF AMERICA?

_________________________________________________________                                    ____________YES       ____________NO  (IF YES, VERIFICATION WILL BE REQUIRED.)

_________________________________________________________                                    I AM SEEKING A PERMANENT POSITION:          ___________YES      _____________NO

_________________________________________________________                                    IF NECESSARY FOR THE JOB I AM ABLE TO:

ARE YOU ABLE TO WORK THE ESSENTIAL FUNCTIONS                                                           WORK (WHICH SHIFTS)    _________________________________________________
OF THE POSITION WITH OR WITHOUT ACCOMMODATIONS?
_________YES         ___________NO                                                                                WORK OVERTIME?  _____________________________________

                                                                                                                                    PROVIDE A VALID FLORIDA DRIVERS LICENSE?  _______________________________

JOB APPLYING FOR:   CARPENTER____________  CARPENTER HELPER______________ SITE SUPERINTENDENT_________________ RECEPTIONIST________________

________________________________________________________________________________________________________________________________________________________________________
IF NECESSARY FOR THE JOB, ARE YOU OVER THE AGE OF 21 YEARS OF AGE?
I WILL BE ABLE TO REPORT TO WORK _________ DAYS AFTER BEING NOTIFIED THAT I AM HIRED.
________________________________________________________________________________________________________________________________________________________________________

EDUCATION                                                                                                                                              YRS. COMPLETED                   FIELD OF STUDY                        GRADUATE OR DEGREE

HIGH SCHOOL  _________________________________________________________________                             ______________        ______________________________        ___________________

COLLEGE/UNIVERSITY  ___________________________________________________________                            ______________        ______________________________        ___________________

BUSINESS/TECHNICAL  ___________________________________________________________                            ______________        ______________________________        ___________________

OTHER  (MAY INCLUDE GRAMMAR SCHOOL)  _________________________________________                            ______________        ______________________________        ___________________
________________________________________________________________________________________________________________________________________________________________________

MILITARY SERVICE:  ___________YES             NO_____________

DUTY/SPECIALIZED TRAINING:  _____________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________

REFERENCES: LIST TWO PERSONAL REFERENCES WHO ARE NOT RELATIVES OR FORMER SUPERVISORS.

________________________________________________________________________________________________________________________________________________________________________
NAME                                                                            ADDRESS                                                                  TELEPHONE                                 OCCUPATION                             YEARS KNOWN

________________________________________________________________________________________________________________________________________________________________________
NAME                                                                            ADDRESS                                                                  TELEPHONE                                 OCCUPATION                             YEARS KNOWN
________________________________________________________________________________________________________________________________________________________________________

EMPLOYMENT:  LIST LAST EMPLOYMENT FIRST. BE SURE ALL YOUR EXPERIENCE OR EMPLOYERS RELATED TO THIS JOB ARE LISTED HERE, IN THE SUMMARY (FOLLOWING THIS SECTION), OR USE 
                        AN EXTRA SHEET OF PAPER IF NECESSARY.

________________________________________________________________________________________________________________________________________________________________________
EMPLOYER NAME AND ADDRESS                                           POSITION TITLE/DUTIES SKILLS                                                                                                  DATES EMPLOYED

____________________________________                                                                                                                                            FROM__________________      TO
  __________________ 

____________________________________

____________________________________                      SUPERVISOR'S NAME                                     TELEPHONE                            REASON FOR LEAVING                             
      
_______________________________________________________________________________________________________________________________________________________________________                                                                    
   ______________________________________________________________________________________________________________________________________________________________________
EMPLOYER NAME AND ADDRESS                                           POSITION TITLE/DUTIES SKILLS                                                                                                  DATES EMPLOYED

____________________________________                                                                                                                                            FROM__________________      TO  __________________ 

____________________________________

____________________________________                      SUPERVISOR'S NAME                                     TELEPHONE                            REASON FOR LEAVING                             
      
_______________________________________________________________________________________________________________________________________________________________________
                                    
________________________________________________________________________________________________________________________________________________________________________
EMPLOYER NAME AND ADDRESS                                           POSITION TITLE/DUTIES SKILLS                                                                                                  DATES EMPLOYED

____________________________________                                                                                                                                            FROM__________________      TO  __________________ 

____________________________________

____________________________________                      SUPERVISOR'S NAME                                     TELEPHONE                            REASON FOR LEAVING                             
      
________________________________________________________________________________________________________________________________________________________________________       EMPLOYER NAME AND ADDRESS                                           POSITION TITLE/DUTIES SKILLS                                                                                                  DATES EMPLOYED

____________________________________                                                                                                                                            FROM__________________      TO  __________________ 

____________________________________

____________________________________                      SUPERVISOR'S NAME                                     TELEPHONE                            REASON FOR LEAVING                             
      
_______________________________________________________________________________________________________________________________________________________________________
_

SUMMARIZE OTHER
EMPLOYMENT RELATED TO THIS JOB:
_________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________

PROFESSIONAL LICENSES, CERTIFICATIONS OR REGISTRATIONS: __________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________

ADDITIONAL SKILLS INCLUDING SUPERVISION SKILLS, OTHER LANGUAGES, OR INFORMATION
REGARDING THE CAREER/OCCUPATION YOU WISH TO BRING TO THE EMPLOYER'S ATTENTION:   ________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________

IN CASE OF AN ACCIDENT OR ILLNESS PLEASE CONTACT:  NAME ___________________________________________________________  PHONE  _______________________________________________

ADDRESS_________________________________________________________________________________________________________  RELATIONSHIP _________________________________________
_______________________________________________________________________________________________________________________________________________________________________

INFORMATION TO THE APPLICANT: AS PART OF OUR PROCEDURE FOR PROCESSING YOUR EMPLOYMENT APPLICATION, YOUR PERSONAL AND EMPLOYMENT REFERENCES MAY BE CHECKED. IF YOU HAVE MISREPRESENTED OR OMITTED ANY FACTS ON THIS APPLICATION, AND ARE SUBSEQUENTLY HIRED, YOU MAY BE DISCHARGED FROM YOUR JOB. YOU MAY MAKE A WRITTEN REQUEST FOR INFORMATION DERIVED FROM CHECKING OF YOUR REFERENCES.

IF NECESSARY FOE EMPLOYMENT YOU MAY BE REQUIRED TO SUPPLY YOUR BIRTH CERTIFICATE OR OTHER PROOF OF AUTHORIZATION TO WORK IN THE U.S., HAVE A PHYSICAL EXAMINATION AND OR DRUG TEST, OR TO SIGN A CONFLICT OF INTEREST AGREEMENT AND ABIDE BY ITS TERMS.

I UNDERSTAND AND AGREE TO THE INFORMATION SHOWN ABOVE:


SIGNATURE___________________________________________________________________  DATE  ___________________________________

________________________________________________________________________________________________________________________________________________________________________

EQUAL EMPLOYMENT OPPORTUNITY
 :  WHILE MANY EMPLOYERS ARE REQUIRED BY FEDERAL LAW TO HAVE AFFIRMATIVE ACTION PROGRAM, ALL EMPLOYERS ARE REQUIRED TO PROVIDE EQUAL EMPLOYMENT OPPORTUNITY AND MAY ASK YOUR NATIONAL ORIGIN, RACE AND SEX FOR PLANNING AND REPORTING PURPOSES ONLY. THIS INFORMATION IS OPTIONAL AND FAILURE TO PROVIDE IT WILL HAVE NO AFFECT ON YOUR APPLICATION FOR EMPLOYMENT.
________________________________________________________________________________________________________________________________________________________________________

EMPLOYER SECTION:






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