Job Application | Gibbs & Register

Employment Application Form

232 South Dillard Street
Winter Garden, FL 34787

Tel: (407) 654-6133

Email: HR@gibbsandregister.com

Looking for a print version? Download the application below.

Application For Employment

Applicacion para Empleo

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Name

First ↑ Please enter your first name.

Last ↑ Please enter your last name.

Middle

Present Address

Street ↑ Please enter your street address.

Number

City ↑ Please enter your city.

State ↑ Please enter your state.

Zip ↑ Please enter your zip code.

How long at current address? ↑ This field is required.

Telephone

Home ↑ Please enter your home phone number.

Cell ↑ Please enter your cell number.

Email ↑ Please enter your email address.

Person to Notify in case of emergency

Name ↑ Please enter the name of your emergency contact.

Relation to you ↑ Please enter the relationship with your emergency contact.

Home Phone # ↑ Please enter a phone number for your contact.

Cell # ↑ Please enter a phone number for your contact.

Within the last 7 years, have you ever been convicted of a crime, pled no contest, or been ordered to pay a fine or court costs as part of a plea bargain?

Yes

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed and type(s) of rehabilitation.

Have you ever been a defendant in a civil lawsuit where you were accused of assault, battery, false imprisonment, or any intentional tort?

Yes

If yes, please explain

Education

High School

Name of school

Location (Complete mailing address)

Number of years completed

Did you earn a high school diploma?

Yes

College

Name of school

Location (Complete mailing address)

Number of years completed

Major & Degree

Bus, or Trade School

Name of school

Location (Complete mailing address)

Number of years completed

Major & Degree

Professional School

Name of school

Location (Complete mailing address)

Number of years completed

Major & Degree

Work Experience

Please list your experience for the past seven years beginning with your most recent job held. If you were self-employed, give firm name. Add as many sections as required.

Please list two references other than relatives

Reference 1

Name

Position

Company

Telephone

Address

Reference 2

Name

Position

Company

Telephone

Address

Other Qualifications

Summarize job-related skills and qualifications acquired and/or professional, trade, business or civic activities and offices held. Please omit any information that would disclose your race, gender, age, marital status, ethnic origin, religious or political affiliations, or disability

May we contact your present or previous employer?

Yes

Did you complete this application yourself?

Yes

If not, who completed it?

Gibbs & Register, Inc. is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with Gibbs & Register, Inc. depends solely on your qualifications

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and accurate.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this application remains current for only 150 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period of definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard.

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 as they are currently constituted or may be changed from time to time.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Signature of applicant ↑ This field is required.

Date ↑ This field is required.

EMPLOYEE ACKNOWLEDGEMENT OF PROBATION /
ADMISIÓN DEL EMPLEADO A PROBACIÓN

I understand that I am on Probation as an employee for the first 90-days of my employment for the purposes of the Florida “Unemployment Compensation Law”. I understand if my employer, Gibbs & Register, Inc. discharges me for unsatisfactory work performance under the Florida “Unemployment Compensation Law” he will not have his account charged for an employment benefits I might be determined eligible for in the future

Yo entiendo que estoy en probatoria como empleado mediante un periodo de noventa (90) días por el propósito de la Ley de Compensación por Desempleo de Florida. Yo entiendo que si mi patrón, Gibbs & Register, Inc. me despide por ejecución no satisfactoria de mi trabajo, bajo la Ley de Compensación por Desempleo de Florida, su cuenta no será cargada por beneficios de empleo los cuales se hubiesen determinado si yo fuese elegible en el futuro. Admito a que he firmado este formulario a poco menos de siete (7) días de mi empleo.

Applicant Signature / Firma del Aplicante ↑ This field is required.

Applicant Name / Nombre del Aplicante ↑ This field is required.

Date / Fecha ↑ This field is required.

DRUG-TESTING CONSENT AND RELEASE /
CONSENTIMIENTO Y RELEVE DEL EXAMEN DE DROGAS

Pursuant to my application for employment, I understand that all job offers are expressly conditioned upon submitting to and passing a drug test to detect the presence of illegal drugs or alcohol use. I hereby consent to submit to a urinalysis or other tests as required by Gibbs & Register, Inc. for the purposes of testing for the presence of illegal drugs or alcohol abuse. I agree that a clinic or laboratory approved by the Florida Agency for Health Care Administration may collect and test any specimens I provide for these tests. I further agree to authorize the release of the results of these tests to the Medical Review Officer employed or retained by the Company, to the Drug-Free Administrator of the Company, and to such other management personnel as may require this information on a need to know basis. My understanding is that any information derived from these tests will be confidential between the laboratory, the Drug Free Administrator of the Company, and the Medical Review Officer, except as otherwise provided by law, or if I place the test or its results in issue in any administrative, legal or other proceeding.

I further agree to release and hold the Company and its agents, employees and assigns, including the laboratory collecting and conducting these tests, harmless from any liability arising in whole or in part out of the collection or testing of the specimens I provide or from the use of the information derived from these tests in consideration of my employment application.

I have carefully read this Consent and Release form and understand it completely. I also understand that execution of the Consent and Release is a condition of employment with Gibbs & Register, Inc./J. Register Co., Inc. and my refusal to sign will result in withdrawal of any offer of employment I may receive. I am signing this form voluntarily and have not been coerced nor placed under duress by any person

De acuerdo a mi aplicación de empleo, yo entiendo que todas las ofertas de trabajo son expresadamente bajo la condición de que se sumita y se pase un examen de drogas para detectar la presencia de drogas ilegales, o el uso de alcohol. Mediante el presente yo consiento a someterme a un análisis urinario, us otros exámenes requeridos pro Gibbs & Register, Inc. para el propósito de examiner la presencia de drogas ilegales, o el uso de alcohol. Estoy de acuerdo a que un laboratorio, o clínica que este aprobado por la Agencia de Administración del Cuidado de la Salud pueda colectar y examinar cualquier espécimen que yo halla proveído para estos exámenes. Además estoy de acuerdo y autorizo a que se releven los resultados de estos exámenes al Oficial de Reviso Medico empleado o retenido por la companía, al administrador de del programa del Trabajo Ligre de Drogas de la companía, y a otro personal de gerencia, como una base de obtener información si se requiere. Mi entendimiento es que cualquier información que salga de estos exámenes, será confidencial entre el laboratorio, el administrador del programa Trabajo Libre de Drogas de la companía, y el official de Reviso Medico, excepto de otro modo que lo provea la ley, o si pongo el examen o sus resultados como problema en cualquier procedimiento administrativo, o legal.

Además, estoy de acuerdo de relevar y mantener a la companía y sus agentes, empledos y asignados, incluyendo al labortorio que colecta y conduce estos exámenes, fuera de peligor de cualquier responsabilidad en parte y por complete que pueda surgir de la colección, o examen de los especimenes que yo prove, o del uso de la información que derive de estos exámenes en consideración con mi aplicación de empleo.

He leído cuidadosamente este formulario de Consetimiento y Releve y lo entiendo completamente. También entiendo que la ejecución de este Consentimiento y Releve es una condición para empleo con Gibbs & Register, Inc./ J. Register Co., Inc. y mi rechazo a firmar resultará en el retiro de cualquier oferta de empleo que haya recibido. Estoy firmando este formulario en voluntad propia y no he sido obligado, o forzado por alguna persona.

Applicant / Solicitante ↑ This field is required.

Date / Fecha ↑ This field is required.

Print Name / NombreDelSolicitante ↑ This field is required.

SSN ↑ This field is required.

Witness

Print Name ↑ This field is required.

Signature ↑ This field is required.

Attach your resume (optional) ↑ Please upload your resume in pdf format.

↑ Please check the box.

TYPING YOUR NAME INTO THE ABOVE SIGNATURE FIELDS IS CONSIDERED YOUR DIGITAL SIGNATURE AND IS BINDING. Thank you for completing this application form and for your interest in our business.

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Employment Application Form