Employment Application
Personal Information
Name
First Name
Last Name
Phone Number
*
Phone Number for Messages
Position Desired
*
Pay Expected
*
Email Address
*
example@example.com
Availability Date
*
/
Month
/
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you at least 18 years of age?
*
Yes
No
Are you legally eligible for employment in the US?
*
Yes
No
Are you available for full-time work?
*
Yes
No
Do you have a current driver's license?
*
Yes
No
If yes, what state?
If yes, what class?
List any traffic violations received within the last 5 years.
*
Do you have any physical health problems that would prevent you from preforming duties common to the construction industry? (lifting, shoveling, etc?)
*
Do you have any physical health problems that would prevent you from preforming duties common to the construction industry? (lifting, shoveling, etc?)
*
Summarize special job-related skills (mechanics, machine operation, etc.) and qualifications.
Are you free to travel outside the state?
*
Yes
No
Are you currently on "lay-off" status and subject to recall?
*
Yes
No
Are you currently employed?
*
Yes
No
Have you ever filed an application with us before?
*
Yes
No
May we contact your present employer?
*
Yes
No
If yes, give date.
/
Month
/
Day
Year
Date
How did you learn about this position? (Please be specific)
Previous Employment History
Employer #1
M
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R
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p
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Company Name
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of employment start, and end?
/
Month
/
Day
Year
Date
-
Month
-
Day
Year
Date
Weekly pay?
Job title and description?
Reason for leaving?
Employer #2
Company Name
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of employment start, and end?
/
Month
/
Day
Year
Date
-
Month
-
Day
Year
Date
Weekly pay?
Job title and description?
Reason for leaving?
Employer #3
Company Name
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of employment start, and end?
/
Month
/
Day
Year
Date
-
Month
-
Day
Year
Date
Weekly pay?
Job title and description?
Reason for leaving?
References
Reference #1
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Reference #2
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reference #3
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Education
P
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S
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College, Technical, or AVTI
Name of School
Location
Course of Study
Number of years completed
Degree?
Did you graduate?
Yes
No
Education
H
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S
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Name of School
Location
Did you graduate?
Yes
No
Military
Branch of Service
Rank at Discharge
Month and year of active duty Start
Month and year of active duty end
Describe your duties and any special training
I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. The applicant understands that neither this document nor any offer of employment from the employer constitute an employment contract unless a specific document to that affect is executed by the employer and employee in writing. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
*
I have read and agree to the statement written above.
Name
*
First Name
Last Name
Date
*
/
Month
/
Day
Year
Date
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