Job Application

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Name*
Address*
MM slash DD slash YYYY
MM slash DD slash YYYY
What is your current employment status?*
Have you ever applied for employment with us before?
Are you available for full time work?
Are you willing to work Saturdays if the job requires?
Are you legally eligible for employment in the United States?
Have you ever been convicted of a felony? (If yes, please explain in the box provided.)
You must be 18 years of age or older to work in the highway/heavy equipment industry. Are you of age to work in this industry?
Projects are typically located within 100 miles of the main office. Are you willing/able to travel the distance the job requires?
Are you willing to work overtime if needed?
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied?

Education

References

Reference 1 Name
Reference 1 Address
Reference 2 Name
Reference 2 Address

PREVIOUS WORK EXPERIENCE

Most Recent Employment

Supervisor Name
Company Address

Second Most Recent Employment

Supervisor Name
Company Address

Third Most Recent Employment

Supervisor Name
Company Address

Additional Skills

DL Class:
CDL?
Is your license valid?
Name as it appears on your license
Address as it appears on your license
Typing your name below will act as your signature.
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MM slash DD slash YYYY

THE INFORMATION BELOW IS TOTALLY VOLUNTARY

PLEASE READ CAREFULLY: As an affirmative action employer, we must monitor our equal opportunity and affirmative action program, and report the results to government agencies. Please help us gather this information by identifying your sex, race or ethnicity and disability status on this form. Providing this information is COMPLETELY VOLUNTARY. If you choose not to provide some or all of this information you will not be subject to any negative or adverse treatment. The information you provide will be used ONLY to monitor our compliance with equal opportunity laws and regulation and for no other purpose. (This form is not used for employment decisions. If you have a disability and need an accommodation so that you can perform the duties of the job for which you are applying please notify us in some other manner). When we receive this form we will immediately place it in a confidential file separate from your application. If you wish, you may mail this form to us in an envelope separate from this application.
Race or Ethnicity
Select one or more:
Are you a person with a disability?
Sex
Select one: