32 CR 5219, Bloomfield, NM 87413
Office: 505/632-8822 - Fax: 505/772-9157
Email: info@taftconstruction.com
In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.
Date:
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Month
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Day
Year
Date
PERSONAL
Name
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First Name
Middle Initial
Last Name
Social Security No.
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Present address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Telephone Number
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Format: (000) 000-0000.
Driver's License #
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State
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Exp. Date
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Do you have a legal right to be employed in the United States?
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Yes (proof required)
No
Are you over the age of 18?
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Yes
No
Race:
White
African American
American Indian
Asian
Native Hawaiian
Ethnicity:
Hispanic
Non-Hispanic
GENERAL
Are you currently employed?
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Yes
No
If yes, where?
Have you ever applied to this company before?
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Yes
No
If so, when?
Position applying for?
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Salary Desired?
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EDUCATION
EDUCATION
Rows
Name & Location of School
Years Attended
Did you Graduate?
Subjects Studied
High School
College
Trade
SPECIAL SKILLS (Check and include years experience)
Skid Steer
Years Experience
Backhoe
Years Experience
Trackhoe
Years Experience
Forklift
Years Experience
Concrete Work
Years Experience
Framing/Remodel/Sheetrock
Years Experience
Welding
Years Experience
Certified
*
Yes
No
Other
Previous Employer Information
Name of Employer
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date worked From
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Month
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Day
Year
Date
Date worked To
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Month
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Day
Year
Date
Salary
Position
Reason for Leaving
Employer #2
Name of Employer
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date From
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Month
-
Day
Year
Date
Date To
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Month
-
Day
Year
Date
Salary
Position
Reason For Leaving
Employer #3
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Worked from
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Month
-
Day
Year
Date
Worked To
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Month
-
Day
Year
Date
Salary
Position
Reason for Leaving
Employer #4
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Worked From
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Month
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Day
Year
Date
Worked To
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Month
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Day
Year
Date
Salary
Position
Reason for Leaving
Back
Next
May we contact your previous employers?
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Yes
No
If No, Why?
REFERENCES GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.
Rows
NAME
PHONE NUMBER / E-MAIL ADDRESS
BUSINESS
YEARS KNOWN
1
2
3
AUTHORIZATION
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and the employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information
I also authorize Taft Construction Company's insurance agent, Woods Insurance to process my driver's license information through the Motor Vehicle Department to check for any/all driving violations and to determine whether I am insurable through Woods Insurance. If it is determined that I am not insurable through Woods Insurance, I will not be offered a position with Taft Construction Company. I also understand that if offered a job, it may be conditioned on the results of a physical examination and drug test. If hired, I agree to abide by all the rules and policies of the employer.
I also understand and agreee that no representative of Taft Construction Company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."
DATE
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SIGNATURE
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