Messinger & Associates, Inc.

Integrity, Priority, Expertise

630 E Jefferson Ave Bastrop, LA 71220 United States

318-281-1636

Messinger & Associates, Inc., is an industry leader, providing professional surveying services to clients. We use the latest software and technology to ensure quality that surpasses client expectations.

Application for Hourly Employment

Messinger & Associates, Inc. is an equal opportunity employer.

Complete the form on this page to submit your application for hourly employment.

Once you have completed this form, you may additionally email your resume as a PDF, DOC, RTF, or TXT attachment to survey@masurvey.net.

Name *

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Length of Residence *

How long have you lived at your current address?

Email Address

Provide your email address if you prefer contact via email.

Date of Birth *

Date of Birth

YYYY

Phone *

Phone

(###)

###

####

Position Interested In

What type of work are you applying for?

Referral

How were you referred to us?

Reference

Please list any current employees of Messinger & Associates you already know.

Residency *

Are you a US Citizen or Permanent Resident Alien?

Yes

Background *

Have you ever been convicted of a felony?

Yes

Felony Explanation

If you answered yes above, please explain.

Work History

List most recent employment first

Employer 1

Employer 1 Name

Employer 1 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer 1 Phone

(###)

###

####

Employer 1 Start Date

YYYY

Employer 1 End Date

YYYY

Employer 1 Type of Work

Type of work you performed

Employer 1 Reason for Leaving

Employer 1 Immediate Supervisor

Employer 1 Hourly Wage

What was your hourly rate?

Employer 2

Employer 2 Name

Employer 2 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer 2 Phone

(###)

###

####

Employer 2 Start Date

YYYY

Employer 2 End Date

YYYY

Employer 2 Type of Work

Type of work you performed

Employer 2 Immediate Supervisor

Employer 2 Hourly Wage

What was your hourly rate?

All Prior Employers

Have you ever been discharged from employment?

Yes

Employment Discharge Explanation

If you answered yes above, please explain.

Education

High School Name

High School Address

High School graduate?

Did you graduate high school or earn equivalent diploma?

Yes

Date of Graduation

If you answered yes above, what year did you graduate?

College or Technical School Name

College or Technical School Address

College or Technical School Major

College major or course of study pursued

College or Technical School Start Date

YYYY

College or Technical School End Date

YYYY

College or Technical School Graduate?

Yes

Military Service

Have you ever served active military duty? *

Yes

Honorable Discharge

If you answered yes above, was your discharge honorable?

Yes

Military Duty Start Date

YYYY

Military Duty End Date

YYYY

Are you a member of the National Guard? *

Yes

National Guard Obligation End Date

If you answered yes above, when does your obligation terminate?

YYYY

Health Information

List any disabilities, allergies, or physical limitations

List date and nature of any disabling injuries or illnesses (mental or physical)

Disability Benefits *

Have you ever applied for or received disability benefits from a government agency, insurance agency, or previous employer?

Yes

Disability Benefits Explanation

If you answered yes above, please explain

Other Information

Training and Skills

List any special skills, training or certifications relevant to the position being applied for

Outside Interests

List any hobbies, recreational or other activities you consider relevant to the position being applied for

Verification *

By entering your initials in the field below and clicking the Submit button to deliver this form, you certify that the foregoing statements are true and correct. You further authorize Messinger and Associates, Inc., to investigate all provided information and to secure additional information, if necessary, as related to the job applied for or promoted to within a reasonable period of time. Any offer of employment may be contingent upon satisfactory completion of a physical examination. You also affirm that you understand that any misrepresentation in this application may constitute cause for dismissal.