Step 1 of 4 25% Employment Application WE ARE AN EQUAL OPPORTUNITY EMPLOYER. WE CONSIDER APPLICANTS FOR ALL POSITIONS WITHOUT REGARD TO RACE, COLOR, CREED, RELIGION, SEX, NATIONAL ORIGIN, AGE, MARITAL OR VETERAN STATUS, THE PRESENCE OF A NON-JOB-RELATED MEDICAL CONDITION OR HANDICAP, AND ANY OTHER LEGALLY PROTECTED STATUS. IT IS OUR POLICY TO ABIDE BY ALL FEDERAL, STATE, AND LOCAL LAWS CONCERNING DISCRIMINATION IN EMPLOYMENT. NO QUESTION IN THIS APPLICATION IS INTENDED TO ELICIT INFORMATION IN VIOLATION OF ANY SUCH LAW NOR WILL ANY INFORMATION OBTAINED IN RESPONSE TO ANY QUESTION BE USED IN VIOLATION OF ANY SUCH LAW. Personal InformationDate of Application* Date Format: MM slash DD slash YYYY Please enter today's date.Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone*Cell PhoneIn case of emergency contactEmergency contact phoneHow did you hear about us?*Were you previously employed by this company?*YesNoIf Yes, Date(s)SupervisorPosition applying for*ForemanFinisherForm SetterDriverSupervisorOffice ClerkWelderMechanicLaborerShop LaborEstimatorParts RunnerCarpenterFull or part timeFull timePart timeAre you willing to work overtime?YesNoAre you currently employed?YesNoWages expectedDate available for work Date Format: MM slash DD slash YYYY Education and TrainingHighest grade completed123456789101112Years of College1234DegreeLast school attendedList any other education, training, special skills, second language, certificates or licensesList any machines or equipment that you are qualified to operatePlease list the amount of experience you have in:Form SettingCurbs & GuttersCatch BasinsSidewalkHeadwallsStructuresAre you able to perform the job(s) for which you are applying?YesNoDo you have your own tools?YesNo List any relatives or friends working for this companyName First Last RelationshipList previous addresses during the last five (5) yearsAddress Street Address City State / Province / Region ZIP / Postal Code How long did you live here?Address Street Address City State / Province / Region ZIP / Postal Code How long did you live here?Address Street Address City State / Province / Region ZIP / Postal Code How long did you live here? Previous EmployersCompanyType of BusinessAddress Street Address City State / Province / Region ZIP / Postal Code Company phoneName and title of supervisorState last job title and describe your positionStarting date Date Format: MM slash DD slash YYYY Ending date Date Format: MM slash DD slash YYYY Starting wageEnding wageMay we contact this employer?YesNoFull or part time?Full timePart timeReason for leavingCompanyType of BusinessAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Company phoneName and title of supervisorState last job title and describe your positionStarting date Date Format: MM slash DD slash YYYY Ending date Date Format: MM slash DD slash YYYY Starting wageEnding wageMay we contact this employer?YesNoFull or part time?YesNoReason for leavingReferences - List business person known, but not related to you, other than those listed aboveNameTitleBusinessPhoneYears knownNameTitleBusinessPhoneYears knownNameTitleBusinessPhoneYears knownHave you been convicted of a crime in the past 7 years, excluding misdemeanors and summary offenses which has not been annulled, expunged, or sealed by a court?YesNoIf yes, please explain. (Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.)Applicant's Certification (Please read carefully before submitting.)*I CERTIFY THAT, TO THE BEST OF MY KNOWLEDGE AND BELIEF, THE ANSWERS GIVEN BY ME TO THE FOREGOING QUESTION AND THE STATEMENTS MADE BY ME IN THIS APPLICATION ARE CORRECT AND COMPLETE. I UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF FACTS IN THE APPLICATION MAY RESULT IN MY DISCHARGE. I AUTHORIZE YOU TO COMMUNICATE WITH THOSE EMPLOYERS I DESIGNATED, SCHOOL OFFICIALS AND PERSONS NAMED AS REFERENCES CONCERNING MY SKILLS, CHARACTER, AND RESPONSIBILITY. IF EMPLOYED, I UNDERSTAND AND AGREE THAT SUCH EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITHOUT PRIOR NOTICE, AND THAT MY EMPLOYMENT WILL NOT BE GOVERNED BY ANY EXPRESSED OR IMPLIED CONTRACT BUT IS AT-WILL.
