Keeler Construction Job Application Form

Application for Employment
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religious persuasion, marital status, sexual orientation, political belief, or disability that does not prohibit performance of essential job functions.
Please choose the Job you are applying for:*
Personal Information:
Full Name*

First NameMiddle NameLast Name
Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Permanent Address (if different than above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.
What made you decide to apply here:*
Are you at least 18 years of age*

YesNo
Birth Date

MonthDayYear
Note: We are required to obtain a work permit from all employees under age 18 before they begin work. Generally, work permits are issued at the school the minor is attending. If you are under 18 and do not currently have a work permit, please contact your school.
Educational History:

Employment Section
NOTE: We will contact all of the employers listed on this application unless you specifically exclude them below. Use the May we contact checkbox.
Current Employment or Most Recent:
Current Employer*
Name of Current Employer or NONE if not Employed
Position Held
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Manager/Supervisor
Reason for Leaving?
Start Date

MonthDayYear
May We Contact?

YesNo
Add additional Employers

YesNo
Previous Employment:
Previous Employer
Name of Previous Employer
Position
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Manager/Supervisor
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
Add additional Employers

YesNo
Previous Employer
Name of Previous Employer
Position
Manager/Supervisor
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear

Skills / Qualifications
Type Of Driver's License

Class DCDL-ACDL B
Driver's License Number
Each person who operates a commercial motor vehicle, who has a commercial drivers license issued by a State Jurisdiction, and who is convicted of violating, in any type of motor vehicle and who is convicted, in any type of motor vehicle, a State or local law relating to motor vehicle traffic control (other than a parking violation) shall notify his/her current employer of such conviction. The notification must be made within 30 days after the date that the person has been convicted.
Do you have your OSHA 10 Hour course certification
What skills, qualifications, or experience do you have that should be considered?

Complete Application
Send Application:
I acknowledge that all the above statements are true. Falsification on an employment application is grounds for immediate termination.
Please verify that you are human*
Should be Empty:

Application for Employment