APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT
939 Parker Farm Road Buxton, Me 04093

207-839-2442

www.gsgravel.com
Position(s) applied for
Date of application

Month Day Year
Date
Reference Source

Relative Advertisement Employee Walk-in Temporary Agency Other
Name of source (if applicable)
Your Information:
First
Last
Middle
Street
Town/State
Zip
Phone#
Email Address
example@example.com
Type of employment desired

Full time Part Time Seasonal Temporary
Have you ever been employed by Gorham Sand & Gravel?

Yes No
If yes, give dates and name of position held:

Month Day Year
Date
Are you legally eligible for employment in this country?

Yes No
Are you at least 18 years of age?

Yes No
Have you ever been convicted of a crime?

Yes No
If yes, please provide dates and details below:
Answering “yes” to these questions does not constitute automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account. Top candidate(s) for positions will be provided with a release/authorization form in order to conduct a background investigation.
If the position sought requires driving, can you provide a valid driver’s license?

Yes No
License Class?
EMPLOYMENT HISTORY
Provide the following information of your past and current employers, assignments or volunteer activities, starting with the most recent. Please explain any gaps in employment in comments section below.
Employer 1
Employer
Job Title
Immediate Supervisor
Address
Telephone
Describe Responsibilities and Duties:
Start Date

Month Day Year
Date
End Date

Month Day Year
Date
Reason for Leaving
May we contact employer for a reference?

Yes No
Employer 2
Employer
Job Title
Immediate Supervisor
Address
Telephone
Describe Responsibilities and Duties:
Start Date

Month Day Year
Date
End Date

Month Day Year
Date
Reason for Leaving
May we contact employer for a reference?

Yes No
Employer 3
Employer
Job Title
Immediate Supervisor
Address
Telephone
Describe Responsibilities and Duties:
Start Date

Month Day Year
Date
End Date

Month Day Year
Date
Reason for Leaving
May we contact employer for a reference?

Yes No
Please add any additional comments, including gaps in employment:
SKILLS AND QUALIFICATIONS
Summarize any special training, skills, licenses (such as a CDL) and/or certificates that may qualify you as being able to perform job related functions in the position for which you are applying.
EDUCATION
List any schools attended, starting with most current. Indicate degree or diploma earned, if any.
School
Degree/Diploma
REFERENCES
List below name and telephone of three business/work references not related to you and are not previous supervisors. If not applicable, list three school or personal references not related to you.
Reference 1
Name
Telephone Number
Years known
Reference 2
Name
Telephone Number
Years known
Reference 3
Name
Telephone Number
Years known
APPLICANT STATEMENT
I certify that all information in the above employment application is true, complete and correct to the best of my knowledge. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause for dismissal. I authorize investigation of all statements contained in this application for employment that may be necessary in making an employment decision.
I certify that I have read, fully understand, and accept all terms of the forgoing Applicant Statement.
Signature of Applicant

Clear
Date

Month Day Year
Date
Should be Empty:

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APPLICATION FOR EMPLOYMENT

Your Information:

EMPLOYMENT HISTORY

Employer 1

Employer 2

Employer 3

SKILLS AND QUALIFICATIONS

EDUCATION

REFERENCES

Reference 1

Reference 2

Reference 3

APPLICANT STATEMENT