Grapevine Solutions Career Application Page 1 of 6Personal InformationUploadUpload Resume, references, cover letter, etc.Contact InformationName*Legal First NameMiddleLegal Last NameDate*Street Address 1*Street Address 2 (Apt. #)City*State*Please selectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code*Phone Type*Please selectMobileHomeWorkPhone Number*Phone TypePlease selectMobileHomeWorkPhone NumberEmail address*Desired EmploymentDesired Position*Please selectTower Tech ITower Tech IITower Tech IIICrew ChiefConstruction ManagerProject ManagerDesired Salary*Available Start Date*Per*Please selectHourWeekYearEmployment InformationAre you a U.S. Citizen?*Please selectYesNoAre you authorized to work in the US?*Please selectYesNoHave you ever been convicted of a felony?*Please selectYesNo(This does not disqualify you from employment)Please explain, in detail*Have you ever worked for Grapevine in the past*Please selectYesNo(This does not disqualify you from employment)Last Date of Employment*Reason for Leaving?*EducationPlease list all formal education, beginning with high school.Type of SchoolPlease selectHigh SchoolCommunity CollegeTrade School/Technical CollegeUniversityFrom:*To:*Did You Graduate?*Please selectStill AttendingYesNoDegree Received*Please selectCurrently AttendingGED/High School Equivalency High School DiplomaProfessional CertificateAssociates DegreeBachelor's DegreeMaster's DegreeHigh School:*College Attended*Field of Study*Type of SchoolPlease selectHigh SchoolCommunity CollegeTrade School/Technical CollegeUniversityFrom:*To:*Did You Graduate?*Please selectStill AttendingYesNoDegree Received*Please selectStill AttendingGED/High School Equivalency High School DiplomaProfessional CertificationAssociates DegreeBachelor's DegreeMaster's DegreeCollege Attended:*Field of Study*Type of SchoolPlease selectHigh SchoolCommunity CollegeTrade School/Technical CollegeUniversityFrom:*To:*Did You Graduate?*Please selectStill AttendingYesNoDegree Received*Please selectStill AttendingGED/High School Equivalency High School DiplomaProfessional CertificationAssociates DegreeBachelor's DegreeMaster's DegreeCollege Attended:*Field of Study*NextPrevious EmploymentIf applicable, please provide three (3) years of verifiable work historyAre you currently Employed*YesNoOtherCurrent Supervisor*Phone Number*Supervisor Email*May We Contact?*Please selectYesNoEmployer AddressWere You Employed Before This Job?*YesNoOtherSupervisor*Phone Number*Supervisor Email*May We Contact?*Please selectYesNoWere You Employed Before This Job?*YesNoOtherSupervisor*Phone Number*Supervisor Email*May We Contact?*Please selectYesNoBackNextReferencesPlease Include three (3) professional referencesReference 1Reference 2Reference 3BackNextEEO-1 Voluntary Self Identification FormThe Equal Employment Opportunity Commission (EEOC) requires all private employers with 100 or more employees as well as federal contractors and first-tier subcontractors with 50 or more employees AND contracts of at least $50,000 complete an EEO-1 report each year. Covered employers must invite employees to self-identify gender and race for this report. Completion of this form is voluntary and will not affect your opportunity for employment, or the terms or conditions of your employment. This form will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records only accessed by the Human Resources department. Please return completed forms to the HR department. If you choose not to self-identify your race/ethnicity at this time, the federal government requires Grapevine Solutions Inc. to determine this information by visual survey and/or other available information.Gender IdentityPlease Select One:*Please selectFemaleMaleOtherI Do Not Wish To DiscloseRace/Ethnicity(Please check one of the descriptions below corresponding to the ethnic group with which you identify.)Please Select One:*Please selectHispanic 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 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.Native American 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 maintains 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.I do not wish to disclose.Disability IdentificationPlease Select One:*Please selectYes, I HAVE a disabilityNo, I DO NOT have a disabilityI choose not to identifyIs your disability one of the targeted disabilities listed below?*Please selectYesNo Blind Convulsive Disorder Partial Paralysis Deaf Mental Retardation Complete Paralysis Missing Extremity (s) Mental Illness Genetic or physical condition affecting limbs or spine BackNextVeteran StatusThe U.S. Department of Labor (DOL), Veterans' Employment and Training Service (VETS) annually collects and compiles the Federal Contractor Veterans' Employment Report (VETS‐100) from federal contractors and subcontractors. Grapevine Solutions Inc. is an Equal Opportunity Employer and ensures its personnel processes provide for careful, thorough, and systematic consideration of the job qualifications of applicants and employees with known disabilities, and for covered Veterans, for job vacancies filled. Grapevine Solutions Inc. takes affirmative action to employ, advance in employment, and otherwise treat qualified individuals without discrimination based on their status as individuals with disabilities and/or Covered Veterans in all employment practices. Under the regulations implementing the affirmative action provisions of VEVRAA issued by the Office of Federal Contract Compliance Programs (OFCCP), a federal contractor is required to invite applicants and current employees to inform the contractor whether they are a Veteran belonging to one or more of the categories of Veterans covered under VEVRAA who wishes to benefit under the contractor's affirmative action program (AAP) for covered Veterans.Electronic Signature*Date*Veteran Status*Please selectYes, I AM a VeteranNo, I AM NOT a VeteranDate of Discharge*Type of Discharge*Please selectHonorableGeneral (Under Honorable Conditions)General (Under Dishonorable Conditions)DishonorableAre You Retired From the Military?*Please selectYesNoDate of Retirement*Can You Identify as a Disabled Veteran?*Please selectYesNoDISABLED VETERAN MEANS: 1‐ A Veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans' Affairs for a disability (A) rated at 30 percent or more, OR (B) rated at 10 or 20 percent in the case of a Veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap 2‐ A person who was discharged or released from active duty because of a service‐connected disability.Can You Identify as a Vietnam Era Veteran?*Please selectYesNoVETERAN OF THE VIETNAM ERA MEANS: A PERSON WHO: 1‐ Served on active duty in the U.S. military, ground, naval or air service for a period of more than 180 days and who was discharged or released with other than a dishonorable discharge, if any part of such active duty was performed: (A) In the Republic of Vietnam between February 28, 1961, and May 7, 1975; OR (B) Between August 5, 1964, and May 7, 1975, in all other cases. 2‐ Was discharged or released from active duty in the U.S. military, ground, naval or air service for a service‐connected disability if any part of such active duty was performed: (A) In the Republic of Vietnam between February 28, 1961, and May 7, 1975; OR (B) Between August 5, 1964, and May 7, 1975, in any other location.Can you identify as Other Protected Veteran?*Please selectYesNoOTHER PROTECTED VETERAN MEANS: Veterans who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized, under the laws administered by the U.S. Department of Defense.Can you Identify as a Recently Separated Veteran?*Please selectYesNo(Veteran within 12 months from discharge or release from active duty)Do you qualify for Veterans Preference?*Please selectYesNo(The last war for which active duty is qualifying for Veterans preference is World War II (12‐7‐41 thru 4‐28‐52)BackNextDisclaimer and SignatureI 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 on my initial application or during my interview may result in my immediate releaseElectronic Signature*Please type your full legal nameDate*Email address*Please type the characters*This helps us prevent spam, thank you.BackSendThis field should be left blank