Application
396 La Luz Gate Road • PO Box 907 • Alamogordo, NM 88311
Ph. (575)437-2995 • Fax (575)437-8358 • humanresources@mesaverdeinc.com
TO BE CONSIDERED FOR EMPLOYMENT, THIS APPLICATION MUST BE RETURNED TO THE HUMAN RESOURCES DEPARTMENT.
This application must be read, signed and filled out in its entirety to be considered for employment. Applications without this form attached will be discarded and not be considered. Applications will be kept on active status for 30 days. Please print, and bring into our office, or email humanresources@mesaverdeinc.com.
We consider applicants for all positions without regard to race, sexual orientation, national origin, gender identity, age, religion, disability, marital or veteran status, or any other legally protected status.
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Drug/alcohol Screening & Physical Acknowledgement and Agreement
By my signature below, I, (print name) _____________________ understand that if considered for “at-will” employment with Mesa Verde Enterprises, Inc., I will be required to submit to a drug/alcohol screening test and physical as a condition of hire. These tests will be scheduled and paid for by Mesa Verde Enterprises, Inc. and will become Mesa Verde property.
My signature below also serves to acknowledge and agree to the fact that if I receive a preliminary offer of employment with Mesa Verde Enterprises, Inc., and accept it, one factor that must be met PRIOR to a final offer of employment being made is a successful completion of a drug/alcohol screening test and physical. Successful completion of a drug/alcohol screening test is defined as test results not detecting the presence of the following drugs: alcohol, amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, methaqualone, opiates, phencyclidine, and propoxyphene. If successful completion of a drug/alcohol screening test and/or physical is not obtained, I understand I will not be eligible for hire with Mesa Verde Enterprises, Inc.
Applicant Signature:_____________________________ Date:________________
APPLICATION FOR “AT-WILL” EMPLOYMENT
This application must be filled out in its entirety to be considered for employment.
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PERSONAL INFORMATION
This application must be filled out in its entirety to be considered for employment.
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PERSONAL INFORMATION
DATE:________________
Name: ___________________________________________
Name: ___________________________________________
(Last, First, Middle)
Social Security #_____________________________
Present Address:______________________________________________
Street, City, State, Zip: ___________________________________________
Permanent Address:____________________________________________
(If different from above address)
Phone:________________________ Are you 18 years or older? Yes __No __
Present Address:______________________________________________
Street, City, State, Zip: ___________________________________________
Permanent Address:____________________________________________
(If different from above address)
Phone:________________________ Are you 18 years or older? Yes __No __
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Are you legally permitted to work in the U.S.? Yes __ No __
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EMPLOYMENT DESIRED
Position ___________________ Date you can start:______________
Salary Desired: $_________________
Are you employed now? If so, may we contact your present employer?___________
Have you ever applied at this company before?________ When?___________________________
Are you employed now? If so, may we contact your present employer?___________
Have you ever applied at this company before?________ When?___________________________
EDUCATION & TRAINING
Name & Location Years Attended * Did You
Graduate?
High School_______ _____________________________________________
College________________________________________________________________________________
Apprenticeship Training______________________________________________________________________
Trade, Business,
or Correspondence_________________________________________________________________________
U.S. Military or Present Membership in
Naval Service Rank National Guard or Reserves
List any experience and/or skills that might be applicable to the job in which you have applied:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
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WE ARE AN EQUAL OPPORTUNITY EMPLOYER
FORMER EMPLOYERS
List all employers, starting with the most recent.
Account for all your time regardless of how spent to include military. (Attach additional sheet if necessary)
Graduate?
High School_______ _____________________________________________
College________________________________________________________________________________
Apprenticeship Training______________________________________________________________________
Trade, Business,
or Correspondence_________________________________________________________________________
U.S. Military or Present Membership in
Naval Service Rank National Guard or Reserves
List any experience and/or skills that might be applicable to the job in which you have applied:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
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WE ARE AN EQUAL OPPORTUNITY EMPLOYER
FORMER EMPLOYERS
List all employers, starting with the most recent.
Account for all your time regardless of how spent to include military. (Attach additional sheet if necessary)
Name, Address & Phone #, Position, Reason For Leaving, Salary.
Name___________________________________________________________
From ______________________________
To _____________________________
________________________________________________$____________________________________
________________________________________________$____________________________________
Name___________________________________________________________
From _____________________________
To _____________________________
________________________________________________$____________________________________
To _____________________________
________________________________________________$____________________________________
Name___________________________________________________________
From _____________________________
To _____________________________
________________________________________________$____________________________________
To _____________________________
________________________________________________$____________________________________
Name___________________________________________________________
From _____________________________
To _____________________________
________________________________________________$____________________________________
To _____________________________
________________________________________________$____________________________________
Name___________________________________________________________
From _____________________________
To _____________________________
________________________________________________$____________________________________
To _____________________________
________________________________________________$____________________________________
Name___________________________________________________________
From _____________________________
To _____________________________
________________________________________________$____________________________________
To _____________________________
________________________________________________$____________________________________
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REFERENCES
(Do not include family members)
NAME __________________________________________________________
(Do not include family members)
NAME __________________________________________________________
ADDRESS ______________________________________________________
PHONE# ______________________________________
RELATIONSHIP__________________________________________
NAME __________________________________________________________
ADDRESS ______________________________________________________
PHONE# ______________________________________
RELATIONSHIP__________________________________________
NAME __________________________________________________________
ADDRESS ______________________________________________________
PHONE# ______________________________________
RELATIONSHIP__________________________________________
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DRIVERS LICENSE INFORMATION
(Motor vehicle records checked on all applicants considered for employment)
LICENSE #, STATE, CLASS, ENDORSEMENTS
____________________________________ ___________________________________
Restrictions: No__ Yes __ If yes, explain:_______________________________________________________
_____________________________________________________________________________________
(Motor vehicle records checked on all applicants considered for employment)
LICENSE #, STATE, CLASS, ENDORSEMENTS
____________________________________ ___________________________________
Restrictions: No__ Yes __ If yes, explain:_______________________________________________________
_____________________________________________________________________________________
WE ARE AN EQUAL OPPORTUNITY EMPLOYER
APPLICANT’S STATEMENT:
I certify that answers given herein are true and I understand that an incomplete application will not be considered for employment.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 30 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
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.
________________________________ _______________
Signature of Applicant Date
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FOR OFFICE USE ONLY
Interviewed by: __________________________________________________ Date____________
Comments:
_______________________________________________________________________________________
Hired? No Yes Position: ___________________________ Department _________________
Salary/Wage: $_________________ Date reporting to work ____________________________________
Notify _______________________________ for review in _______________ days.
(Attach interview checklist) _________________________________
Hired by:
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396 La Luz Gate Road, Alamogordo, NM 88310 • Ph. (575)437-2995
Affirmative Action Applicant Data Record
Mesa Verde Enterprises, Inc. is an Equal Opportunity Employer. As required by law, we must record certain information to be made a part of our Affirmative Action Program.
For use by government contractors
Applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap. As an employer/government contractor, we comply with government regulations and affirmative action responsibilities. Solely to help us comply with government record keeping, reporting and other legal requirements, please fill out the Applicant Data Record. We appreciate your cooperation. Refusal to provide this information will not subject you to adverse treatment. This data is for periodic government reporting and will be kept in a confidential file separate from the APPLICATION FOR EMPLOYMENT:
(PLEASE PRINT)
Position(s) applied for ________________________________________________________________
APPLICANT’S STATEMENT:
I certify that answers given herein are true and I understand that an incomplete application will not be considered for employment.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 30 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
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.
________________________________ _______________
Signature of Applicant Date
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FOR OFFICE USE ONLY
Interviewed by: __________________________________________________ Date____________
Comments:
_______________________________________________________________________________________
Hired? No Yes Position: ___________________________ Department _________________
Salary/Wage: $_________________ Date reporting to work ____________________________________
Notify _______________________________ for review in _______________ days.
(Attach interview checklist) _________________________________
Hired by:
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396 La Luz Gate Road, Alamogordo, NM 88310 • Ph. (575)437-2995
Affirmative Action Applicant Data Record
Mesa Verde Enterprises, Inc. is an Equal Opportunity Employer. As required by law, we must record certain information to be made a part of our Affirmative Action Program.
For use by government contractors
Applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap. As an employer/government contractor, we comply with government regulations and affirmative action responsibilities. Solely to help us comply with government record keeping, reporting and other legal requirements, please fill out the Applicant Data Record. We appreciate your cooperation. Refusal to provide this information will not subject you to adverse treatment. This data is for periodic government reporting and will be kept in a confidential file separate from the APPLICATION FOR EMPLOYMENT:
(PLEASE PRINT)
Position(s) applied for ________________________________________________________________
Date _________________
REFERRAL SOURCE
__Advertisement __Friend __Relative __Walk-in __Employment Agency __Other
=============================================================
Applicant Name ________________________________________________________________
__Advertisement __Friend __Relative __Walk-in __Employment Agency __Other
=============================================================
Applicant Name ________________________________________________________________
Last, First, Middle,
Address__________________________________________________________
Street, City, State, Zip code
Street, City, State, Zip code
Phone Number ___________________________________________________
AFFIRMATIVE ACTION SURVEY
Government agencies require periodic reports on the sex, ethnicity, disability and veteran status of applicants. This data is for analysis and affirmative action only. Submission of this information is voluntary. Check one: ___Male ___Female Race/Ethnic Group: (Check one of the following) ___ Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
___ White (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
___ Black or African American (Not Hispanic or Latino) – A person having origins in any of the black racial groups of Africa.
___ Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) – A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
___ Asian (Not Hispanic or Latino) – 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, and Vietnam.
___ American Indian or Alaska Native (Not Hispanic or Latino) – A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
___ Two or More Races (Not Hispanic or Latino) – All persons who identify with more than one of the above five races.
___ Race missing or unknown - Applies to Applicants only, where a resume or application that is screened is received without any racial or ethnic identification and no further contact is made with the applicant.
Check if any of the following are applicable: ___Vietnam Era veteran ___Disabled veteran ___Disabled individual
AFFIRMATIVE ACTION SURVEY
Government agencies require periodic reports on the sex, ethnicity, disability and veteran status of applicants. This data is for analysis and affirmative action only. Submission of this information is voluntary. Check one: ___Male ___Female Race/Ethnic Group: (Check one of the following) ___ Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
___ White (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
___ Black or African American (Not Hispanic or Latino) – A person having origins in any of the black racial groups of Africa.
___ Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) – A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
___ Asian (Not Hispanic or Latino) – 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, and Vietnam.
___ American Indian or Alaska Native (Not Hispanic or Latino) – A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
___ Two or More Races (Not Hispanic or Latino) – All persons who identify with more than one of the above five races.
___ Race missing or unknown - Applies to Applicants only, where a resume or application that is screened is received without any racial or ethnic identification and no further contact is made with the applicant.
Check if any of the following are applicable: ___Vietnam Era veteran ___Disabled veteran ___Disabled individual
FOR PERSONNEL DEPARTMENT USE ONLY
Position(s) sought is/are open: ___Yes ___No Position(s) considered for: __________________________________________ Date: ________________
Position(s) sought is/are open: ___Yes ___No Position(s) considered for: __________________________________________ Date: ________________