Employment Application

Step 1 of 7 - Contact Information

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Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Date of Birth(Required)

MM slash DD slash YYYY

Email(Required)

Phone(Required)

Social Security #

Position Applied for

How did you hear about this opening?

When can you start?(Required)

MM slash DD slash YYYY

Desired Wage

Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation.)(Required)

Yes

Are you looking for full-time employment?(Required)

Yes

If no, what days are you available?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

If no, what hours are you available on those days?

Do you have a valid driver’s license?(Required)

Yes

State of Issue

State

Expiration Date

MM slash DD slash YYYY

Do you have a CDL?(Required)

Yes

Do you with hold a DOT Medical Card?

Yes

Expiration Date

MM slash DD slash YYYY

What is your means of transportation to work?(Required)

Have you ever operated a Skid Steer, Excavator, Truck with trailer or other heavy machinery?(Required)

Have you ever worked for this company?(Required)

Yes

Are you capable of lifting more than 50lbs?(Required)

Yes

Are you capable of working in rainy, snowy, hot, humid weather conditions?(Required)

Yes

Have you ever been convicted of a felony? (This will not necessarily affect your application.)(Required)

Yes

If yes, please describe conditions.

Conditions of hiring or continued employment(Required)

I agree

I understand and agree that I may be required to take one or more: Physical Examination, Drug Test, Lie Detector Test.

As a condition of hiring or continued employment. I agree to consent to take such test(s) at such time as designated by the company and to release the Company, its directors, officers, agents or employees from any claim arising in a connection with the use of such test(s).

I have been advised that lie detector tests, as a condition of hiring or continued employment, are prohibited by law

Yes

High School Name & Location

Year of Graduation

College Degree or Other Training?

Year of Graduation

In addition to your work history, are there other skills, qualifications, or experience that we should consider?(Required)

Most Recent Employment

Company Name(Required)

Company Phone(Required)

Address(Required)

Street Address City State ZIP Code

Date Started(Required)

MM slash DD slash YYYY

Starting Wage(Required)

Starting Position(Required)

Date Ended

MM slash DD slash YYYY

Ending Wage

Ending Position

Name of Supervisor(Required)

Supervisor Phone(Required)

Responsibilities(Required)

Reason for leaving(Required)

Past Employment

Company Name

Company Phone

Address

Street Address City State ZIP Code

Date Started

MM slash DD slash YYYY

Starting Wage

Starting Position

Date Ended

MM slash DD slash YYYY

Ending Wage

Ending Position

Name of Supervisor

Supervisor Phone

Responsibilities

Reason for leaving

Application Consent(Required)

By checking this box, I am certifying that the facts set forth in this application or employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history. I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing.

Your Name(Required)

First Last