Employment Application

Position Applying For*
Last Name
First Name
Middle Name
Street Address
City
State
Zip Code
Home Phone
Cell Phone
Email
Position Applying For
Why are you applying for work at Monument?
If hired, would you have a reliable means of transportation to and from work?
- Yes
- No
Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.)
- Yes
- No
Have you ever been convicted of a felony?
- Yes
- No
If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?
- Yes
- No
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
- Yes
- No
Describe the functions that cannot be performed.
(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.)

High School
School Name
School City/State
Years Completed
Did you graduate? Yes/No
Degree/Diploma
College/University
School Name
School City/State
Years Completed
Degree/Diploma
Did you graduate? Yes/No
Vocational/Business
School Name
School City/State
Years Completed
Did you graduate? Yes/No
Degree/Diploma

List below all present and past employment starting with your most recent employer (last five years is sufficient). Account for all periods of unemployment. You must complete this section even if attaching a resume.
Name of Employer
Phone
Type of Business
Supervisors Name & Title
Street Address
City
State
Zip Code
Dates Employed
From To
Job Title
Description of duties
Reason for Leaving?
May we contact this employer?
- Yes
- No
Name of Employer (Second Most Recent)
Phone
Type of Business
Supervisors Name & Title
Street Address
City
State
Zip Code
Dates Employed
From To
Job Title
Description of Duties
Reason for Leaving?
May we contact this employer?
- Yes
- No
Would you like to list another previous job?
- Yes
- No
Name of Employer (Third Most Recent)
Phone
Type of Business
Supervisors Name & Title
Street Address
City
State
Zip Code
Dates Employed
From To
Job Title
Description of Duties
Reason for Leaving?
May we contact this employer?
- Yes
- No

List below three persons not related to you who have knowledge of your work performance within the last three years.
Reference Number One
First Name
Last Name
Phone Number
Address
Occupation
Years Known
Reference Number Two
First Name
Last Name
Phone Number
Address
Occupation
Years Known
Reference Number Three
First Name
Last Name
Phone Number
Address
Occupation
Years Known

Please Read Carefully and Agree to Each Paragraph
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
- Yes
- No
I hereby authorize Monument to thoroughly investigate my references, work record, education and other matters related to my suitability for employment (excluding criminal background information) and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
- Yes
- No
I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company's designated representative.
- Yes
- No
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United State and to complete the required employment eligibility verification document form upon hire.
- Yes
- No
- I waive receipt of a copy of any public record described in the paragraph above.
Digital Signature
Printing your First Name + Middle Initial + Last Name will act as your digital signature.