EMPLOYMENT APPLICATION

The Don Chapin Company, Inc.

560 Crazy Horse Canyon Road
Salinas, CA 93907-8402
(831) 449-4273
(831) 449-4500 Fax
DonChapin.com

The DON CHAPIN COMPANY, INC. IS AN EQUAL OPPORTUNITY EMPLOYER

State and federal laws prohibit discrimination in employment because of Ancestry, Gender/Gender Identity/Gender Expression, Sexual
Orientation, Marital Status, Race including Religious Dress and Grooming Practices, Color, Religion or creed, National origin or
ancestry including Language Use, Sex including Pregnancy, Childbirth, Breastfeeding and/or Related Medical Conditions, Age (over
40), Physical or mental disability including HIV/AIDS, Medical Condition including Genetic Characteristics, Cancer or History of
Cancer, Veteran status or Military Status, Genetic information, Citizenship, or any other characteristic protected by federal, state or
local law.

NOTE: Please answer all questions completely and accurately. False or misleading statements on this form
and/or during the interview maybe grounds for terminating the application process, or if discovered after
employment, terminating the employment relationship. Department of Motor Vehicle printout sheet of driving
record must be submitted with the Application for Employment.

PERSONAL INFORMATION
Please print clearly. Use additional pages as necessary. Date of Application: ________________________

1. Name:
Last First Middle

2. Address:
Street City State Zip

3. Telephone Number: ( ) - 4. Email Address

5. Are you at least 18 years old? Yes No If employed & under the age of 18, can you furnish a work permit? Yes No

6. Do you have a legal right to work in the United States? Yes No

If employed, you will be required to provide proof.

7. Have you applied to The Don Chapin Company, Inc. for employment in the past? Yes No
If yes, when? Position applied for:

8. Do you have any relatives currently employed by The Don Chapin Company, Inc? Yes No
If yes, who? What relation to you?

9. Have you ever used another name that we would need to verify your employment experience and education?
Yes No If yes, indicate such name and the date the name changed:

10. Are you currently employed? Yes No If yes, may we contact your current employer at any time? Yes No
You may contact my current employer, but only when:

Employment Application - ©2010 Revised 12/2017 BLC Partners, LLC Page 1 of 4

POSITION

1. Position for which you are applying:

First Choice Second Choice
2. Salary/wage desired: per

3. Are you available to work: Full-Time Part-Time Temporary On-Call

Evenings Weekends Overtime Split Shift
Other:

4. When would you be available to start working?

5. How did you hear about the availability of the position for which you are applying?
Newspaper Advertisement Employment Agency Current Employee
Friend Relative Walk-In Other:

6. If the position you are applying for requires the use of a vehicle, do you have a valid driver’s license? Yes No
License #: Class: State: Expiration Date:

7. Have you been given a Job Description, or have the requirements of the job been explained to you? Yes No
Do you understand these requirements? Yes No

8. Can you perform any or all of the job functions for the position you are seeking, either with or without reasonable
accommodation? Yes No

9. Can you meet the attendance standard of our company, which requires all employees to report for work on time for
all scheduled days or shifts? Yes No

SPECIAL SKILLS AND TRAINING

1. Describe specialized training, apprenticeships, skills or research:

2. List current certifications and/or professional licenses, if any, and where registered:

3. Office/business equipment and software qualified or trained to use:

Please Check Software and List Programs

4. Check special skills or training: (i.e., Word, Excel, etc.):
General Office Customer Service Word basic adv.
Procedures Bookkeeping Excel basic adv.
Internet Savvy Accounting Crystal Reports basic adv.
Management Written/Verbal Accounting basic adv.
Computer Skills Communication Skills
Construction Front Desk/Information Other basic adv.

5. Please indicate any language skills, other than English, below:

READING SPEAKING UNDERSTANDING WRITING

LANGUAGE
FLUENT GOOD FAIR FLUENT GOOD FAIR FLUENT GOOD FAIR FLUENT GOOD FAIR

Employment Application - ©2010 Revised 12/2017 BLC Partners, LLC Page 2 of 4

EMPLOYMENT EXPERIENCE

Directions: Begin with your present or last job. Account for all periods of time, including military experience,
and periods of unemployment and the nature of your activities. Since we will make every effort to contact
previous employers, the correct telephone numbers are appreciated.

THE FOLLOWING MUST BE COMPLETED IN DETAIL – RESUMES ARE NOT ACCEPTED IN LIEU OF THIS INFORMATION.

1. Employer Dates Employed Key Responsibilities

From To
Address
Full-Time Part-Time
Telephone Number Supervisor’s Name, Title and Telephone Number

Job Title

Reason for Leaving: Resigned Laid off Discharged

Why?

2. Employer Dates Employed Key Responsibilities

From To
Address
Full-Time Part-Time
Telephone Number Supervisor’s Name, Title and Telephone Number

Job Title

Reason for Leaving: Resigned Laid off Discharged

Why?

3. Employer Dates Employed Key Responsibilities

From To
Address
Full-Time Part-Time
Telephone Number Supervisor’s Name, Title and Telephone Number

Job Title

Reason for Leaving: Resigned Laid off Discharged

Why?

4. Employer Dates Employed Address Job Title

from to

5. Employer Dates Employed Address Job Title

from to

6. Employer Dates Employed Address Job Title

from to

7. Employer Dates Employed Address Job Title

from to

Employment Application - ©2010 Revised 12/2017 BLC Partners, LLC Page 3 of 4

EDUCATION AND TRAINING
TYPE of SCHOOL SCHOOL NAME, CITY and STATE MAJOR Choose Last Year

High School N/A 9 10 11 12

From:
Community College Degree: Yes No 1 2
To:
From:
College/University Degree: Yes No 1 2 3 4
To:
From:
Graduate School Degree: Yes No 1 2 3 4
To:
From:
Business/Trade/Night School Degree: Yes No 1 2 3 4
To:

EMPLOYMENT REFERENCES

Name Business Relationship Organization/Address Telephone

CERTIFICATION
DIRECTIONS: PLEASE READ THE FOLLOWING CAREFULLY AND INITIAL BEFORE SIGNING THIS APPLICATION FORM.
I hereby certify that I, the undersigned applicant, have personally completed this application. I further understand
that any omission or misstatement of material fact on this application or on any document used to secure
employment shall be grounds for rejection of this application or for immediate discharge by The Don Chapin
Company, Inc. regardless of the time elapsed before discovery. I additionally certify that I have not knowingly
withheld any information that might adversely affect my chances for employment and that the answers given by me
are true and correct to the best of my knowledge.
I hereby authorize The Don Chapin Company to thoroughly investigate my references, work record, education and
other matters related to my suitability for employment unless otherwise specified above. I further, authorize the
references I have listed to disclose to the company any and all letters, reports and other information related to my
work records, without giving me prior notice of such disclosure. In addition, I hereby release The Don Chapin
Company, my former employers and all other persons, corporations, partnerships and associations from any and
all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. I further
authorize The Don Chapin Company to request and consider a Department of Motor Vehicles driving record if my
position required me to operate a motor vehicle on behalf of the Company.
I understand that nothing contained in the application, or conveyed during any interview which may be granted or
during my employment, if hired, is intended to create an employment contract between me and The Don Company.
In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period
and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and
that no promises or representations contrary to the foregoing are binding on the company unless made in writing
and signed by me and the President of the Company.
If employed by The Don Chapin Company, Inc., I agree to abide by the rules, policies and procedures of The Don
Chapin Company, Inc. and subsequent rules, policies and procedures that may become effective after employment.
I understand that my initial and continued employment may be contingent upon the successful completion of a
medical examination, and such examination may include drug and alcohol screening. I understand that The Don
Chapin Company, Inc. believes strongly in a drug-free work environment and agree to abide by the drug and alcohol
policies of The Don Chapin Company, Inc. during the time of my employment. Pre-employment drug screen is
required if you are a successful applicant and are hired.
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 form upon hire.

Signature of Applicant Date

Employment Application - ©2010 Revised 12/2017 BLC Partners, LLC Page 4 of 4