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Personal Information

Employment Desired

Education History

High School

Trade / College / Other

General Information

Former Employers

List your last 4 employers or last 7 years of employment starting with the most recent 


Give the names of 3 people not related to you whom you have known for at least 1 year

Self-identification information for EEOC

Applicants are considered for all positions without regards to age, citizenship, color/race, disability, ethnic background, gender identity, genetic information, marital status, national origin, pregnancy, race, religion, religious beliefs, sex, sexual orientation, or veterans’ status. As an Affirmative Action/Equal Opportunity Employer, Absolute Caulking & Waterproofing Inc., complies with government regulations and affirmative action responsibilities. You are invited to complete the Applicant Self-Identification form to assist us with government record keeping, reporting & other legal requirements. That data is for analysis & affirmative action purposes. Submission of information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential & will only be used in accordance with the provisions of applicable laws, executive orders, & regulations, including those that require the information to be summarized & reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual. Completion of information below is voluntary. Thank you for your cooperation.


American Indian or Alaskan Native: A person having origins in any of the original peoples of North & South America (including Central America), & who maintains tribal affiliation or community attachment.
Asian: A person having origins in any of the original peoples of the Far East, Southeast, Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand & Vietnam
Black or African American: A person having origins in any of the black racial groups of Africa
Hispanic/Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish cultures or origin, regardless of race
Native Hawaiian or Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samona, or other Pacific Islands
White or Caucasian: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa

The information requested is intended for use solely in connection with its affirmative action obligations or its voluntary affirmative action efforts; and the specific information is being requested on a voluntary basis, it will be kept confidential in accordance with the ADA, refusal to provide it will not subject you to any averse treatment, and it will be used only in accordance with the ADA

Veterans Status

*A “disabled Veteran” is one of the following: -A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or -A person who was discharged or released from active duty because of a service-connected disability
*A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service
*An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the law administered by the Department of Defense.
*An “armed forces service medal veteran” means a veteran who, while service on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation of which an Armed Forces service medal was awarded pursuant to Executive Order 12985. Protected veterans may have additional rights under USERRA-the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor’s Veterans Employment and Training Service (VETS), toll free at 1-866-4-USA-DOL.
If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box. As a Goverenment contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

Voluntary Self-Identification of Disability

Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2020

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.
If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history of record of such and impairment or medical condition.
Disabilities include, but are not limited to: *Blindness *Deafness *Cancer *Diabetes *Autism *Cerebral Palsy *HIV/AIDS *Schizophrenia *Bipolar disorder *Major depression *Multiple Sclerosis (MS) *Epilepsy *Post-traumatic stress disorder (PTSD) *Obsessive compulsive disorder *Impairments requiring the use of a wheelchair *Muscular dystrophy *Intellecutal disability (previously called mental retardation) *Missing limbs or partially missing limbs

Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.


I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or othewise, and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.
I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment.
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document upon hire.