Careers at Cameron Home Insulation

FIRST NAME
MIDDLE NAME
LAST NAME
ADDRESS
STATE
ZIP CODE
HOME TELEPHONE
CELL PHONE
EMAIL
In case of an emergency, I authorize you to contact:
FULLNAME
CELL PHONE

Tell Us About Yourself
What position are you applying for?
What is your salary expectation?
When can you start work?
MM slash DD slash YYYY
How were you referred to us?
Are there any days or times during the week that you are not available to work?
- Yes
- No
If yes, please list the days/times you are not available to work
If necessary, can you provide proof that you are over any minimum work age requirement?
- Yes
- No
Are you willing work overtime?
- Yes
- No
Do you have steady transportation to work?
- Yes
- No
What percentage of time?
- Yes
- No
Are you on layoff and subject to recall?
- Yes
- No
May we contact your present employer?
- Yes
- No
How much time have you lost from work during the past 12 months?
Are you now, or do you expect to be, engaged in any other business or employment while working here?
- Yes
- No
If yes, please explain
Are you presently an officer to a Non-Compete Agreement or Restrictive Covenant that would prohibit you from working at our company?
- Yes
- No
If yes, please explain
Have you been terminated or asked to resign from a job?
- Yes
- No
If yes, please explain
Why do you desire to make a change?
Are you legally eligible to work in the United States? (Proof required upon hire)
- Yes
- No
What three things are most important to you in job? 1
What three things are most important to you in job? 2
What three things are most important to you in job? 3
What three adjectives best describe you? 1
What three adjectives best describe you? 2
What three adjectives best describe you? 3
What type of work do you most enjoy?
Why do you want to work here?

Tell Us About Your Special Skills and Qualifications
List any special skills, talents, experience, certifications, or licenses that may be relevant to this position or our company
List any professional, trade, business, or civic activities of offices held that would relate to working here
List any languages that you fluently speak, read, and/or write that would relate to working here
List software programs that you are proficient in

Your Educational Background
High School or GED
Did you graduate?
- Yes
- No
HS Years Completed
HS Degree Received & Major Subject
HS Name of School
HS Location
Trade, Business, or Correspondence
TBC Did you graduate?
- Yes
- No
TBC Years Completed
TBC Degree Received & Major Subject
TBC Name of School
TBC Location
College
College Did you graduate?
- Yes
- No
College Years Completed
College Degree Received & Major Subject
College Name of School
College Location
Graduate School
GS Did you graduate?
- Yes
- No
GS Years Completed
GS Degree Received & Major Subject
GS Name of School
GS Location

Your Military Services
Branch of service
Rank at discharge, if applicable
List duties, special training, and/or skills
Driving Record
Do you hold a valid Driver's License?
- Yes
- No
If yes, provide the state
Have you been convicted of any moving violations(s) in the last 3 years?
- Yes
- No
If yes, give date(s) and explanation of each

Tell Us About Any Records (Must be answered by all candidates)
Have you ever been convicted of, received a sentence for, pled nolo contender (no contest) to, or been placed on probation or fined by any judicial or quasi-judicial body for a crime, other than a minor traffic violations? (Arrest records or juvenile, sealed or expunged records should not be disclosed. Any other criminal record not disclosed by you may be considered falsification of this application, which may result in revocation of your employment offer or termination of your employment. Also, accordance with any state or federal regulations, you may required to provide copies of any criminal records.
Answering "yes" to this question is not an automatic bar to emplyment. See below for specific instruction related to the state in which you are applying for employment. If the state in which you are applying for employment is not listed, answer this question as worded)
- Yes
- No
If yes, describe the details of the conviction, the sentence for the conviction, the date of the offense (month and year), your age at the time of the offense, and your rehabilitation since the conviction:
California Candidates
- Do not dislcose convictions that have been sealed, expunged, or statutorily eradicated, or for which you were referred to, and participated in any pre-trial or post-trial
- Do not disclose misdemeanor convictions for which probation has been successfully completed or discharged
- Do not disclose convictions that are more than two years old for marijuana possessions, possessions of marijuana pipes or paraphernalia, operations of business that displays or sells marijuana paraphernalia in areas accessible to minors and being under the influence of marijuana
Connecticut Candidates
- Do not disclose erased records of arrests, criminal charges or convictions
- Applicants with erased criminal records can swear under oath that they have never been arrested.
- Criminal records eligible for erasure include delinquency determinations, findings as a child in a family with service needs, youhtful offender adjudications, dismissed or no fled criminal charges, criminal charges where the accused was found not guilty or received an absolute pardon, and any other conviction where erasure is allowed by law.
Hawaii:
- Do not disclose erased records of arrests, criminal charges, or convictions
- Applicants with erased criminal records can swear under oath that they have never been arrested.
- DO NOT ANSWER THIS QUESTION UNLESS you (1) have been given a conditional job offer or (2) have been notified that you are applying for a position state or federal law that expressly permits criminal history inquiries. If you have been given a conditional job offer; limit your answer to the above 10 years period
Massachusetts Candidates
- DO NOT ANSWER THIS QUESTION UNLESS you (1) are applying for a job at a company with fewer than 6 employees or (2) ave been notified that you are applying for a position covered by a state or federal law or regulation that includes disqualification based on a conviction if either of these exceptions apply, then
- List felony convictions AND list any misdemeanors that you were convicted of within the past 5 years excluding first convictions for drunkiness, simply assault, speeding, minor traffic violations, affray, or disturbance of the peace.
- Applicants for employment with a sealed record on a file with the Commision of Probation may answer "no record" with respect to an inquiry herein relative to prior arrests, convictions, criminal court appearances, adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the Superior Court for criminal prosecutions
Nevada Candidates:
- List felony convictions and any misdemeanor convictions that occured in the past 10 years and that resulted in imprisonment.
North Dakota Candidates:
- List felony convictions and any misdemeanor convictions that occured in the past 10 years and that resulted in imprisonment.
Ohio Candidates:
- List felony convictions and any misdemeanor convictions that occured in the past 10 years and that resulted in imprisonment.
Pennsylvania Candidates:
- List felony convictions and any misdemeanor convictions that occured in the past 10 years and that resulted in imprisonment.
Utah Candidates:
- List felony convictions and any misdemeanor convictions that occured in the past 10 years and that resulted in imprisonment.
Washington Candidates:
- List felony convictions and any misdemeanor convictions that occured in the past 10 years and that resulted in imprisonment.

Tell Us About Your Past (Answering "yes" to any of these questions is not an automatic bar to employment.)
Have you ever been diciplined or terminated from any job for an act of violence, harasment, discrimation, ethical breach or theft?
- Yes
- No
If yes, explain the circumstances, employer, and date
Have you ever been a defendant in a civil action for an intentional tort? (eg. assault, battery, false imprisonment, infliction of emotional distress, tortuous interference with a business relationship, defamation invasion of privacy, fraud and misrepresentaion, abuse of process and malicious prosecution of others)
- Yes
- No
If yes, provide an explanation of the nature of the international tort, the date of the action, the location, and the disposition and the outcome
Do you have currently have any criminal charges pending against you for which you have been not arrested?
- Yes
- No
If yes, describe the details of the charge(s), the date(s) of the offense(s) (month and year), your age the time of the offense(s), and the current status of the charge(s)
Are you currently wanted by any law enforcement agency?
- Yes
- No
If yes, by what agency and for what act?

Your Work History and Any Employment Gaps(Must be completed even when accompanied by resume) List most recentir current job first. You must include any gaps in employment, with a full explanation and dates for the gap. You must also provide a complete work history.
Work History 1
WH1 Employer
WH1 Dates Employed From
WH1 Dates Employed To
WH1 Address
WH1 Earnings From
WH1 Earnings To
WH1 Job Title
WH1 Supervisor's Name
WH1 Summary of Work Performed and Job Responsibilities
WH1 State the Reason Why The Job was Ended
Work History 2
WH2 Employer
WH2 Dates Employed From
WH2 Dates Employed To
WH2 Address
WH2 Earnings From
WH2 Earnings To
WH2 Job Title
WH2 Supervisor's Name
WH2 Summary of Work Performed and Job Responsibilities
WH2 State the Reason Why The Job was Ended
Work History 3
WH3 Employer
WH3 Dates Employed From
WH3 Dates Employed To
WH3 Address
WH3 Earnings From
WH3 Earnings To
WH3 Job Title
WH3 Supervisor's Name
WH3 Summary of Work Performed and Job Responsibilities
WH3 State the Reason Why The Job was Ended

Agreement and Release
For the purpose of this agreement and release, the company you are applying for employment with is referred to as "the company", "this company", or "you" in the following paragraphs.

The facts set forth above in my application for employment are true and complete. I understand that false statements or omission of information on this application (even if discovered after employment) or any other employment form may lead to dismissal or denial of employment. You are hereby authorized to make any investigation of my personal history, financial,criminal, credit, and motor vehicle records through any investigative or credit agencies or bureaus of your choice. You are also authorized to administer a personality profile or other pre-employment tests and verify my background. A criminal record or sentence is not an automatic disqualification for employment. I agree to submit to any drug or alcohol testing prior to or after employment, and I agree to submit to a medical evaluation, if required. I consent to the release to the release of any or all medical information or records deemed necessary to determine my capability to perform the essential job functions of the position for which I may hold.

In making this application for employment, I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends, or other with whom I am acquainted. In exchanged for the consideration of my employment application by this company, I hereby release and forever discharged this company (including their directors, officers, employees, and agents) and my past and/or present employers (including their directors, officers, employees, and agents) from any liabilities which may result from an investigation of my past and/or present employment or from the disclosure of such information. I authorized the use of any information in this application to verify my statements, and I authorized my past employers, doctors, all references, and and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record.

I understand that if my application is accepted and if I am hired, that employment with this company at all times is employment "at will". It is further understood that this "at will" relationship may not be changed by any written document, verbal statement, or by conduct unless an authorized executive of this company specifically acknowledges such change. I further understand that my "at will" employment may be terminated at any by this company or myself and includes no guarantee, contract, or promise of employment for any specific length of time. I understand that the first 90 days of employment is a new-hire introductory period. Submission of this application does not imply that you will be hired. I have read, understand, and by my signature consent to these statements.
AR Signature of Applicant*
AR Date
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Join an Award-Winning Team

Step 1 of 9

High School or GED

Trade, Business, or Correspondence

College

Graduate School

California Candidates

Connecticut Candidates

Hawaii:

Massachusetts Candidates

Nevada Candidates:

North Dakota Candidates:

Ohio Candidates:

Pennsylvania Candidates:

Utah Candidates:

Washington Candidates:

Work History 1

Work History 2

Work History 3

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