APPLICATION FOR EMPLOYMENT

MUST BE COMPLETED IN FULL

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Name:

Present Address:

Permanent Address:

Phone:

Employment Position(s) Desired:

Date You Can Start:

Salary Desired

Are you presently employed?

Yes

If yes, may we inquire with your present employer (name & phone number)?

If you know anyone in our employment, state name and relationship:

Are you legally eligible for employment in this country?

Yes

Are you able to meet the attendance requirements of this position?

Yes

How did you hear about our company?

Have you ever pled “guilty” or “no contest” to, or been convicted of a crime?

Yes

If yes, please provide date(s) or details (Due to some jobsites we are asked to perform work on, a criminal background check will be performed. We would just like to know up front and not when you are denied on a jobsite.)

Driver's License # & State:

Disclaimer

*The Age Discrimination Employment Act of 1967 prohibits discrimination based on age with respect to individuals who are older.

Name Of School

Name Of School

Location

Location

Did You Graduate?

Did You Graduate?

High School:

Location:

Did You Graduate?

College:

Location:

Did You Graduate:

Trade or Correspondence School:

Location:

Did You Graduate:

General Experience:

General Experience, please indicate all that apply using the following:

1 = 3 or more years experience 2 = less than 3 years experience or leave blank = none

Flatsawing:

Wire Sawing:

Excavator:

List Others:

Core Drilling:

Bobcat:

Concrete Crushing:

List Others:

Wallsawing:

Grinding:

Grooving/Grinding:

List Others:

Electric Flatsaw:

Hy-Ram:

Hand Demo:

Truck Driver:

Former Employees:

FORMER EMPLOYERS (LIST STARTING WITH THE LAST ONE FIRST)

Date (Month/Year)

Date (Month/Year)

Name and Address

Name and Address

Position

Position

Salary

Salary

Reason for Leaving

Reason for Leaving

From - To:

Name and Address:

Position:

Salary:

Reason for Leaving:

From - To:

Name and Address:

Position:

Salary:

Reason for Leaving:

From - To:

Name and Address:

Position:

Salary:

Reason for Leaving:

Reference:

REFERENCES: Give below the names of three persons not related to you, whom you have known at least one year.

Name:

Address:

Phone Number:

Years Acquainted:

Name:

Address:

Phone Number:

Years Acquainted:

Name:

Address:

Phone Number:

Years Acquainted:

Authorization:

I authorize the investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further I understand and agree that my employment has no definite period and may, regardless of the date of payment of my wages or salary, may be terminated at any time without any previous notice.

APPLICATION FOR EMPLOYMENT

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