GALLIAN ONLINE APPLICATION

Please fill out the fields below and we will get back to you promptly. If you feel that you need to speak with us please call (405) 359-1777

Introductory Information:

Position Applied For: Desired Hourly Rate:
Full Name: (First, Middle Initial, Last)
Date of Birth: (Month, Day, Year) SSN:
Telephone: Home Cell
Address: Number and Street City State Zip
Email:

Emergency Contact Information:

Name:
Home #:
Work #:
How is this person related to you?

Additional Information:

Have your wages ever been garnished? Yes No
If yes, explain:
Have you filed a worker’s comp claim in the last 5 years? Yes No
Are you under legal obligation to pay child support? Yes No
Have you ever been employed with Gallian Masonry before? Yes No
If so, when? to: Position (s) Held:
Are you legally eligible to work in the United States? Yes No
Proof of identity and eligibility for employment in the United States will be required upon employment.

Background Information:

Have you been convicted of a felony in the past 12 months? Yes No
Have you served time for a felony in the past 12 months? Yes No
Have you ever been convicted of any offense against the law? Yes No
Omit juvenile offenses and minor traffic violations.
If you answered yes to the question above, please explain:

Educational Background:

High School/GED

Name and location of school:
Years Completed:
Diploma/Degree Received:

College/University

Name and location of school:
Years Completed:
Diploma/Degree Received:
Major Course of Study:

Graduate/Professional

Name and location of school:
Years Completed:
Diploma/Degree Received:
Major Course of Study:

Work Experience:

Begin with your current or most recent job. Include also, any military or volunteer experience.
Employer:
Telephone Number:
Address:
Job Title:
Supervisor:
Start Date: (Month, Day, Year) End Date: (Month, Day, Year)
Starting Rate of Pay: Final Rate of Pay:
Work Performed:
Reason for Leaving:
Explain:

Employer:
Telephone Number:
Address:
Job Title:
Supervisor:
Start Date: (Month, Day, Year) End Date: (Month, Day, Year)
Starting Rate of Pay: Final Rate of Pay:
Work Performed:
Reason for Leaving:
Explain:

May we obtain employment references from your past employers? Yes No
May we obtain employment references from your current employer? Yes No
May we conduct a background check (if applicable) of your qualifications and character? Yes No
If no, please explain:

NOTE: Gallian Masonry is a DRUG FREE WORKPLACE

The following statement must be agreed to. Please read carefully.

I certify that all of the statements made in this application are true and complete to the best of my knowledge. I understand that any falsification or misrepresentation may be cause for not employing me, or for my dismissal, if employed.

I understand that all information on this application is subject to verification. I authorize Gallian Masonry to obtain references concerning my credit, employment, DMV report and work history, and I release the aforementioned from all liability for issuing such information.

I aggree: Yes No