PSC Application

Application for Employment

WA Contractor # CONSTAI083L5
Applicants are considered for all positions iwthout regard to race, religion, sex, national origin, age, marital or veteran status or the presence of a non-job related medical condition or disability. THIS IS NOT AN OFFER OF EMPLOYMENT.
THIS APPLICATION MUST BE FILLED OUT COMPLETELY TO BE ELIGIBLE FOR CONSIDERATION OF EMPLOYMENT.
Full Name*

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
E-mail*
Referral Source*
If friend or relative works here, please fill out first name and last name*
Please answer the following questions, explain answers where requested.
Position Applying For
Date You Can Start

MonthDayYear
Have you worked here before?

YesNo
Are you currently employed?

YesNo
Are you on lay-off and subject to recall with a Union?

YesNo
If hired, do you intend to work for any other employer?

YesNo
If yes, identify employer, position, & hours of work?
Are you able to perform the primary functions of the position for which you are applying with or without accommodation?

YesNo
If no, explain:
Do you have a current and valid driver's license?

YesNo
State:
Number:
Type:
Endorsements:
Expiration Date:
Do you have a current and valid flagger certification?

YesNo
Number:
Expiration Date:
Do you have a current First Aid and/or CPR card?

YesNo
Expiration Date:
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

YesNo
Has any license, permit, or privilege ever been suspended or revoked?

YesNo
Have you ever been denied insurance coverage?

YesNo
Is your license currently active and in good standing?

YesNo
Were you involved in any accidents during the last 3 years?

YesNo
If yes, to the questions above include nature of accident, date, and number of injuries
Have you received any traffic convictions and/or forfeitures during the last 3 years?

YesNo
If yes, include location, date, charge, and penalty.
Have you ever been convicted of a felony or misdemeanor in the last 10 years (Exclude convictions that have been sealed or expunged from record)?

YesNo
If yes, include location, date, charge, and outcome of charge.
List your last three years of residency:
Include Location & dates
Education:
High School
Name of High School Attended
Number of Years Attended
Graduated?

Yes
College
Name of College/University Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Graduate School
Name of Graduate School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Work Experience and Trade Skills:
Please indicate number of years and months experience in each.
Skills
List any other skills and/or experience, equipment operated, etc., that you believe make you qualified for the position(s) you are applying for.
Employment History:

All applicants MUST complete employment history for the previous 10 years. Start with your present job and include dates of unemployment, military service assignments, volunteer activities, and education. DO NOT LEAVE ANY UNACCOUNTED TIME. Exclude organization names that indicate race, color, religion, sex, or national origin. If additional space is necessary, please upload a separate sheet.
Current Employer*
Name of Current Employer or NONE if not Employed
Position*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Starting Wage
Ending Wage
Reason for Leaving?*
May We Contact?

YesNo
Previous Employment:
Previous Employer
Name of Previous Employer
Position
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Starting Wage
Ending Wage
Reason for Leaving?
May We Contact?

YesNo
Previous Employer
Name of Previous Employer
Position
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Starting Wage
Ending Wage
Reason for Leaving?
May We Contact?

YesNo
Previous Employer
Name of Previous Employer
Position
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Starting Wage
Ending Wage
Reason for Leaving?
May We Contact?

YesNo
Previous Employer
Name of Previous Employer
Position
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Starting Wage
Ending Wage
Reason for Leaving?
May We Contact?

YesNo
References:

Please include at least 2 professional references.
Name

First NameLast Name
Phone Number

Area CodePhone Number
May We Contact?

YesNo
Name

First NameLast Name
Phone Number

Area CodePhone Number
May We Contact?

YesNo
Cover Letter, Resume, other history (Optional):
Upload a File

Cancelof
EMPLOYMENT HISTORY

I certify that this application was completed by me, and all entries on it and in it are true and complete to the best of my knowledge. I understand that I may be required to submit additional information, if requested. I authorize investigation of all statements contained in this application for employment and any other supplemental applications I may complete, as well as statements I make during interviews, as may be necessary in arriving at an employment decision.

In the event of employment, I understand that incomplete, false, or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by rules and regulations of the company.

If hired, you have the right to end your employement with the company for any reason and at any time you wish. The copany reserves the right to do the same. This application and the personnel policies of the company are not to be considered a contract of employment.
Signature

Clear
Date

MonthDayYear
Date
RELEASE FOR INFORMATION FROM PREVIOUS EMPLOYERS REGARDING GENERAL EMPLOYMENT INFORMATION

I, below signed, hereby authorize Construction Ahead, Inc. to request information from my previous employer(s) for purposes of investigations required by Federal Motor Carrier Safety Regulations and/or company policy. I understand that any information received from previous employers will be considered in arriving at an employment decision.

I also authorize my previous employer(s) to release information regarding my past employment history. Previous employer(s) are released from any and all liability which may result from furnishing such information.
Signature

Clear
Date

MonthDayYear
Date
RELEASE FOR INFORMATION FROM PREVIOUS EMPLOYERS REGARDING SUBSTANCE ABUSE RECORDS

I, below signed, hereby hat my previous employer(s) release and forward all information on my Alcohol adn Controlled Substances Testing and Training records to Pavement Surface Control for purposes of investigation required by the Federal Motor Carries Safety Regulations and/or company policy. I understand that any information received from previous employers will be considered in arriving at an employment decisions.

I also authorize my previous employer(s) to release information regarding my past Alcohol and Controlled Substances Testing and Training records. Previous employer(s) are released from any and all liablility which may result from furnishing such information.
Signature

Clear
Date

MonthDayYear
Date

Now create your own Jotform - It's free!Create your own Jotform

Application for Employment

Education:

Work Experience and Trade Skills:

Employment History:

Previous Employment:

References:

Cover Letter, Resume, other history (Optional):

Applicant Data Record:

Send Application: