New Hire Forms

Employee Information Summary

Personal Information

First Name: *

Middle Initial: *

Last Name: *

Preferred Name *

Mailing Address *

Apartment/Unit #

City *

State *

Zip *

Social Security Number *

Date of Birth *

Home Phone

Cell Phone *

Email Address *

Marital Status *

Are you a military veteran? *

Do you have any of the following?

TWIC Card

OSHA 10

OSHA 30

Passport

Emergency Contact Information

Name *

Primary Phone *

Alternate Phone

Personal Information (Voluntary Self-Identification)

Ethnic Group: You are not required to complete this information. It is for statistical and governmental reporting purposes only. This data is kept confidential and will only be used in accordance with applicable state and federal laws. If you choose not to provide this information, your decision will not affect your employment.

To be completed by the office

Job Title

Employment Type

Full Time

Part Time

Temporary

Hire Date

Rate per hour

Employee DB number

Date

Welcome to Jackson & Jackson Industrial Contractors, Inc. Please fill out the following forms and submit to complete your employment. If you have any questions please contact the office at 936-257-9114.

Employee Information Summary

Personal Information

Emergency Contact Information

Personal Information (Voluntary Self-Identification)

To be completed by the office