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William H. Smith and Associates, Inc. Surveying Consultants (WHS) considers all applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, marital or military status, or based on any individual’s status in any group or class protected by applicable federal, state, or local law. WHS also provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require an accommodation in the application process, please advise WHS Management.

FULL NAME

Last

First

Middle

CURRENT ADDRESS

Street

City

State

Zip

PREVIOUS ADDRESS

Street

City

State

Zip

Home Phone

Cell Phone

Preferred Method of Contact

BEST DAYS TO REACH YOU

BEST TIME TO REACH YOU

MondayTuesdayWednesdayThursdayFriday

8AM - 12PM12PM - 5PMAfter 5PM

Position Sought

Date Available for Work

Type of Work Sought (check all that apply)
Full-TimePart-TimeTemporary

Have you previously applied for a position with WHS?
YesNo

If yes, date applied and position applied for:

How did you hear about us?

Employee ReferralJob BoardNewspaper AdWHS WebsiteCollege/UniversityOther

Desired Wage/Salery*

*Note: Applicants who fail to provide desired wage information will not be considered.

Are you willing to relocate, if necessary?
YesNo

Are you willing to travel, if necessary?
YesNo

Are you a U.S. citizen, or are you otherwise authorized to work in the U.S. without restriction?
YesNo

If selected for employment, are you willing to submit to background screening, including a pre-employment drug screening?
YesNo

Have you been convicted of a felony in the past seven (7) years*?
YesNo
*In answering this question, you are not obligated to disclose any convictions that have been sealed, annulled, expunged,dismissed, erased, impounded, cleared, vacated, or officially pardoned.

If yes, please describe the circumstances:

Do you have a current driver's license?
YesNo

If yes, in which state and class of license?

Has your driver's license ever been revoked or suspended?
YesNo

If yes, please provide reason and dates:

EDUCATION & CERTIFICATIONS

Highest Degree Obtained

May we contact institutions you attended to verify the above information?
YesNo

Please list educational institution you attended, whether your degree was completed or not.

School Name

Degree Sought:

Major

Was degree obtained?
YesNo

If yes, date received:

Dates of Attendance:
Start Date:

End Date:

EDUCATION & CERTIFICATIONS
Please Check All That Apply

Microsoft WordMicrosoft OutlookMicrosoft Power PointMicrosoft ExcelQuickbooksAutoCAD Civil 3DAutoCADCarlson

Other SoftwareAccounts PayableAccounts ReceivableAdminstrativeBook KeepingEngineerEITPLS

LSITParty ChiefSurvey TechHelperDesign ManagerDraftspersonOffice ManagerProject Manager

If yes to AutoCAD, AutoCAD Civil, Carlson or "Other" please describe and/or list version of software.

Please list any additional skills, qualifications, or experience which you feel is relevant to the position you are applying for:

PROFESSIONAL REFERENCES
Please provide names, work relationships, email addresses (if available) and telephone numbers for at least three supervisors/managers or other professional references that are not related to you whom we may contact:

REFRENCE 1

Full Name

Title

Relation to Applicant

Phone

REFRENCE 2

Full Name

Title

Relation to Applicant

Phone

REFRENCE 3

Full Name

Title

Relation to Applicant

Phone

ACKNOWLEDGEMENT & AUTHORIZATION FORM
I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment, as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Applicant Name:

Applicant Signature (initials):

Dated:

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