Music City Center Workforce Development Application
 

An Equal Employment Opportunity
All job classifications and positions will be filled without discrimination on the basis of a qualified applicant's race, color, religion, sex, age, disability, national origin, citizenship, veteran status or any other characteristic protected by state or federal law.

* Denotes Required field
Contact Information

*Last

  

*First

  

MI

  

Date

 
  ex. mm/dd/yyyy
*Street Address

Apartment Unit #

  

*State

  

* City

   * Zip  
*Phone1 Phone2   E-mail  

* Are you eligible for employment in the U.S.

  

* Have you ever been convicted of a felony or misdemeanor? (exclude minor traffic violations)?

  

If Yes, Please Explain
 

  
 
Availability

I am Available to work:

 Day Mon  Tue  Wed  Thu  Fri  Sat  Sun Shift         Shift 1 Shift 2  Shift 3
List 3 References
* Contact Name: * Job Title:

 

 * Phone:  
Contact Name:    Job Title:

 

 Phone:  
Contact Name:   Job Title:

 

 Phone:  
* Where you referred by a community based organization?  

 If Yes, Please identify:

  

If you are interested in employment/training and contracting opportunities, please complete this form. If you are a contractor in business, please visit the Music City Center website to complete the vendor pre-qualification application.

Trade Expertise/Skills/Certifications
   *Have you received a High School Diploma/G.E.D.? 

* Please list all of the trade expertise/skills/and certifications you have:

 
 
Employment History
Please list previous employers and construction related work experience beginning with your most recent job held.
* Name of Employer: * Phone:

 

 * Supervisor:  

* Address

  

* State

* City

 * Zip

  
* Job Title From:  Starting Pay  
Reason for Leaving To:    Ending Pay  
* Responsibilities  
* Skills/Tools/ Certifications  
Name of Employer: Phone:

 

  Supervisor:  

Address

  

State

 City

 Zip

  
 Job Title  From:  Starting Pay  
Reason for Leaving  To:   Ending Pay  
Responsibilities  
Skills/Tools/ Certifications  
Name of Employer: Phone:

 

  Supervisor:  

Address

  

State

 City

 Zip

  
 Job Title  From:  Starting Pay  
Reason for Leaving  To:   Ending Pay  
Responsibilities  
Skills/Tools/ Certifications  
Name of Employer: Phone:

 

  Supervisor:  

Address

  

State

 City

 Zip

  
 Job Title  From:  Starting Pay  
Reason for Leaving  To:   Ending Pay  
Responsibilities  
Skills/Tools/ Certifications  
Name of Employer: Phone:

 

  Supervisor:  

Address

  

State

 City

 Zip

  
 Job Title  From:  Starting Pay  
Reason for Leaving  To:   Ending Pay  
Responsibilities  
Skills/Tools/ Certifications  
Military Service
Branch From To

Rank at Discharge

Type of Discharge
Up load Resume
Attach: 

SELF-IDENTIFICATION FORM FOR RACE, GENDER, EDUCATION LEVEL, VETERAN STATUS, OR DISABILITY STATUS

To help us maintain demographic information about our applicants, we want to give you the opportunity to self-identify; however, providing the information is voluntary. It will be kept strictly confidential, and plays no role in employment.
I self-identify with the following group: Please mark one of the following categories (defined by Governmental terms):
ASIAN All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine islands, Thailand,and Vietnam.
BLACK All persons having origins in any of the Black racial groups of Africa.
HISPANIC All persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
NATIVE HAWAIIAN OR OTHER PACIFIC  
     ISLANDER		 All persons having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.
AMERICAN INDIAN OR ALASKA NATIVE All persons having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. Meets Bureau of Indian Affairs definition standards.
WHITE A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
TWO or MORE RACES (not Hispanic or
     Latino)		 All persons who identify with more than one of the above six races.
Gender:
Please select one        MaleFemale
Level of Education:
Please select, if applicable   GED/High School Diploma     Some College     College Diploma
I qualify under the Affirmative Action Program as:
A Special Disabled Veteran Receives 30% disability).
A Vietnam era Veteran (Republic of Vietnam service between 02/28/61 & 05/07/75; or military service between 08/05/64 & 05/07/75).
An Other Eligible Veteran (Active duty service member receiving campaign or expeditionary badge)
An Individual with a Disability ( A person who has a physical or mental impairment which substantially limits one or more of such person's major life activities.)

I understand that this information will be kept confidential, except as required, in conjunction with the federal regulations.
 
Disclaimer and Signature
-I certify that my answers are true and complete to the best of my knowledge.
-If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
-This application is good for 6 months from the date received in the office:
*Signature:

 

 *Date:    ex. mm/dd/yyyy
 

Example: 0000rety   Signature Last 4 digit of SSN first 4 letters of last name