SUB-CONTRACTORS INFORMATION

If you are a human and are seeing this field, please leave it blank.

Name *

Last name *

Phone *

Email *

Address *

State *

City *

Zip / Post Code *

SSN: *

Do you have a USA valid driver’s license? *

Driving licence Number *

Car: Make, Model, Year *

Licence Plate Number *

Insurance Company and Policy Number *

Do you have the legal right to work permanently in the United States? *

Have you ever been convicted of a felony or misdemeanor: *

If yes, what was the nature of the offense(s):

I authorized to run a background check:

Work Experience: *

Employer: *

Phone: *

Job Title: *

Employed (month/year) Start and End: *

Hourly Salary: *

Reason for Leaving: *

If this is your current or last job employer may we contact?: *

1.-Personal References Give the name; address and telephone number who are not related to you: *

2-.Personal References Give the name; address and telephone number who are not related to you: *

Family member. Give the name; address and telephone number who are related to you: *

By signing this application, I certify: That this application is complete and accurate to the best of my knowledge and that I have not made any attempt to conceal information and that falsification could be cause for dismissal. Further, Laura Johnson or its agents may request employment information from my previous employers and persons or corporations who provide information related to my previous employment and will be released from any liability or damage. I Have noted that Laura Johnson is an Equal Opportunity Employer and ad applicants receive lawful consideration for employment without regard to Race, Religion, Color, Sex, Sexual orientation, Age, National origin, Disability, or Veteran Status. I realize that if I am hired, Laura Johnson reserves the right to terminate my employment whenever the need arises. *

SUB-CONTRACTORS/COMPANIES/INDIVIDUAL INFORMATION