Allen Contracting & Shell Construction Application Part 1

Name (Nombre)*

First (Primero)Middle (Medio)Last (Último)
SSN (Número de la seguridad social)*
Current Address (Direccion Actual) *

Street Address (Calle)

Street Address Line 2

City (Ciudad) State (Estado)

Zip (Código Postal)
Phone (Teléfono) *
Format: (000) 000-0000.
Email*
example@example.com
Date You Can Start*

MonthDayYear
Fecha en que usted puede comenzar
Referred By
Position Applying For*
Pay Rate Desired
YesNo
YesNo
YesNo
YesNo
If yes, when?
YesNo
If yes, who?
YesNo
YesNo
YesNo
EnglishSpanishOther
YesNo
If yes, explain/dates
Education
High School*
City*
State*
From*
To*
YesNo
Diploma
College/Trade School
City
State
From
To
YesNo
Degree
Experience
BulldozerRollerBackhoeMotor GraderScraperLoaderCertified Crane
Years
SkilledUnskilled
Years
Truck/TrailersDump TruckConcrete Mixer
Years
Concrete FinisherPipe LayerCarpenterForm BuilderAsphalt
Years
MS ExcelMS WordMS OutlookMS Office
Years
Please list other special training and/or skills related to the position to which you are applying:
References

Please list three professional references
Reference 1*

NameRelationship
CompanyPhone Number
Reference 2*

NameRelationship
CompanyPhone Number
Reference 3*

NameRelationship
CompanyPhone Number
Previous Employment

All applicants: Must show at least past 7 years of job history. List current or most recent job first. Explain gaps in employment.
Company*
Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Supervisor*
Job Title*
Starting Salary
Ending Salary
From*
To*
Responsibilities*
Reason For Leaving*
YesNo
Previous Employment 2
Company
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
Reason For Leaving
YesNo
Previous Employment 3
Company
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Supervisor
Job Title
Starting Salary
Ending Salary
YesNo
Explain any gaps in employment.
Voluntary Identity Self Disclosure

Allen Contracting, Inc. / Shell Construction Company, Inc. are contractors subjected to the rules and regulations of U.S. Government Executive order 11246, as amended, which requires the company to employ, upgrade, transfer, promote, layoff, or terminate without regard to race, age, color, religion, sex, disability, or national origin. The U.S. Government requires Allen Contracting, Inc. / Shell Construction Company, Inc. to maintain the information requested below for the purpose of determining the impact of Allen Contracting, Inc. / Shell Construction Company, Inc. employment procedures. This information will be kept confidential. It will be filed separately from your application form and if employed, separate from your personnel file. This information will only be used in accordance with prescribed federal regulations.

NOTE: The information requested in this form is completely voluntary and will be kept confidential. We will use the data you provide us for periodic government reporting purposes only. Also, this form will be stored separately from each employee’s personnel file. Refusal to provide this information will NOT subject you to any adverse treatment. However, your cooperation in this would be greatly appreciated.
NameDatePosition Applying For
Social Security NumberDate of Birth
Alaskan or American IndianAsianBlack or African AmericanHawaiian or Pacific IslanderHispanic or LatinoWhiteTwo or More Races
Military Service

BranchFromTo
Rank at DischargeType of Discharge
I authorize investigation on all statements contained in this application. I understand that misrepresentation of information requested is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may; regardless of the date of payment of my wages and salary, be terminated at any time without case and without any previous notice.
Date*

MonthDayYear
Date
Signature*

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Education

Experience

References

Previous Employment

Previous Employment 2

Previous Employment 3