Application Form

1

Position Applied For

Position*

Employment Type Desired*

Desired Start Date*

Desired Pay Rate (hourly or salary)

If "Other," describe the position you are seeking

Are you willing to work overtime when required?*

Yes No

Are you willing to travel or work at job sites outside Mobile?*

Yes Limited travel only No

How did you hear about this position?

2

Personal Information

Notice: Integrity Maintenance is an Equal Opportunity Employer. We do not discriminate based on race, color, religion, sex, national origin, age, disability, or any other protected class. The information below is used solely to process your application.

First Name*

Middle Name / Initial

Last Name*

Street Address*

Apt / Unit

City*

State*

ZIP Code*

Primary Phone*

Alternate Phone

Email Address*

3

Education

School / Institution	Location	Degree / Diploma / Certificate	Graduated?	Year

Apprenticeship Programs Completed (union or non-union)

4

Employment History

Most recent first · List last 10 years

List your last three employers. Include self-employment, military service, and contract work. Gaps exceeding 30 days must be explained in the final field below.

Employer 1 — Most Recent

Company Name*

Industry / Trade

Address / City, State

Supervisor Name

Supervisor Phone

May we contact?

Your Title / Position*

Start Date

End Date (leave blank if current)

Starting Pay

Ending Pay

Reason for Leaving

Primary Duties and Responsibilities

Explain any employment gaps exceeding 30 days

5

Trade Skills & Certifications

Licenses & Certifications — Check all held and provide license number / expiration where applicable.

Certification / License	Held?	Number	Expires
OSHA 10-Hour (Construction)
OSHA 30-Hour (Construction)
First Aid / CPR
NCCER Core / Trade Credentials
HVAC EPA 608 (Type I / II / III / Universal)
Electrical License (AL or other state)
Plumbing License (AL or other state)
Forklift / Aerial Lift Certification
Commercial Driver's License (CDL)

Other Certifications, Licenses, or Training Not Listed Above

Do you hold a valid driver's license?*

Yes No

License State & Number

Do you have reliable transportation to job sites?*

Yes No

Do you own or have access to hand tools / power tools?

Yes Partial set No

6

Professional References

Do not list relatives or former employers listed above

#	Full Name	Relationship / Title	Company	Phone	Email
1
2
3

7

Safety & Background Disclosures

Notice: A conditional offer of employment may be contingent upon a background check, drug screen, and/or physical examination as permitted by applicable law. A criminal conviction does not automatically disqualify an applicant.

Military Service — Branch, Dates, and Type of Discharge (optional)

Are you subject to any non-compete or non-solicitation agreement with a current or former employer?

Yes No

Additional Information You'd Like Us to Know

8

Certification & Electronic Signature

Applicant Certification Statement

I certify that all information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that any false statement, omission, or misrepresentation may disqualify me from employment consideration and, if discovered after employment, may result in immediate termination regardless of when discovered.

I authorize Integrity Maintenance LLC to verify all information provided on this application, including contacting former employers, educational institutions, professional references, and any other sources deemed necessary. I release Integrity Maintenance and any persons or entities providing information from all liability arising from such verification.

I understand that employment with Integrity Maintenance is at-will, meaning either party may terminate the employment relationship at any time, with or without cause or advance notice, unless otherwise required by applicable law. Nothing in this application constitutes a contract of employment.

I understand that if offered employment, I will be required to provide documentation verifying my identity and eligibility to work in the United States as required by the Immigration Reform and Control Act (IRCA), and that employment is conditioned upon satisfactory results of any required background check, drug screen, and/or pre-employment physical examination.

I acknowledge that this application will remain active for 60 days from the date submitted. If I wish to be considered after that period, I must reapply.

Drug-Free Workplace Notice: Integrity Maintenance maintains a drug-free workplace. As a condition of employment, employees may be subject to pre-employment, random, post-accident, and reasonable-suspicion drug and alcohol testing.

Equal Employment Opportunity: Integrity Maintenance is an equal opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Full Legal Name (Typed Signature)*

Today's Date*

I have read, understand, and agree to the Applicant Certification Statement above. I certify that all information provided is true and accurate.*

I consent to a background check and drug screen as a condition of a potential offer of employment.

✓ Application Received