Job Application Form

Employment Application

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General Information

First Name:

MI:

Last Name:

Address:

Street

City

State

Zip Code

SSN:

Phone #:

Position Applying for?

(Operator-scraper, loader, etc/Trucker Driver-water truck, haul truck, etc./Laborer/Mechanic/Oiler/Other)

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Personal Information


Are you looking for a career or job?	Career Job

Have you worked for this company before?	Yes No
If yes, when and who was the project supervisor?

Date available for work?

If hired can you provide verification of your legal right to work in the U.S.?	Yes No

Do you have a valid Drivers License?	Yes No
If yes, please list the state issued in and the License #

Please List the Class of Driver's License and any Endorsements you have

Do you have a clean motor vehicle record for the past 3 years?	Yes No

If no, please list your driving violations:


Would you be available to work overtime?	Yes No

Would you be available to work on weekends?	Yes No

Do you need any reasonable accommodation in the hiring process that may help you demonstrate your qualifications to perform the duties of the job?	Yes No

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Employment Information

Current or Previous Employer 1

Supervisor's Name		Phone:

Full Address		Zip Code:

Position Held

Reason for Leaving

Account for period in between jobs - give dates and reason:


Previous Employer 2

Supervisor's Name		Phone:

Full Address		Zip Code:

Position Held

Reason for Leaving

Account for period in between jobs - give dates and reason:


Previous Employer 3

Supervisor's Name		Phone:

Full Address		Zip Code:

Position Held

Reason for Leaving

Account for period in between jobs - give dates and reason:


Equipment	Employer		Period of Employment/Experience
			From:	To:

			From:	To:

			From:	To:

			From:	To:

Education, Background and Training: List special training or on the job education



References: List three references that may be contacted to verify your work experience
Contact	Position/Job Title		Company	Phone

APPLICANT MUST READ AND TYPE NAME TO SIGNIFY ACCEPTANCE

I certify that I have read and understood all of this employment application. It is agreed and understood that the employer or his agents may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or not, and I release employers and other persons named herein from all liability for any damages on account of furnishing such information. I understand that as an applicant for a position with this company I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a physical examination and drug test.

I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment with the employer and for no other reason.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigative Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal. If hired, I agree to abide by all the rules and policies of the employer.

By submitting this application, including electronically, this certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. This application is current for forty five (45) days. Thereafter, if you have not heard from us and still wish to be considered for employment , it will be necessary for you to fill out a new application.

Type Your Full Name Here

Date