It is our policy to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability, or veteran status.

1. Applicant name:
Address:
City/State/Zip:
Number of years at this address:
Daytime phone: Evening phone:

2. Job/Position applied for:

3. Salary desired:

4. Referral source: Who referred you to our company?

5. Have you applied to our company before? YES/NO YES NO

6. Are you at least 18 years old? YES/NO YES NO

7. Are you currently employed? YES/NO YES NO
If so may we contact this employer?  YES/NO YES NO

8. If you were offered employment, when would you be able to work?

9. Are you legally eligible for employment in the United States? YES/NO YES NO

10. Are you able to perform the essential functions of the job applied for with or without reasonable accommodation? YES/NO YES NO

11. Do you have a driver’s license? YES/NO YES NO

12. Have you been convicted of a felony in the last 7 years? YES/NO YES NO
Have you been convicted of drug charges in the past 7 years? YES/NO YES NO
Are there any DUI’s on your driving record? YES/NO YES NO
If you have answered yes to any of these questions please explain:

13. Applicant Employment History: List your current or most recent employment first

14. Applicant’s education and training:

High school name and address:
Last grade completed? Select... 9 10 11 12 Diploma? YES/NO YES NO

College name and address:
Did you receive a degree? YES/NO YES NO

Other training or skills:

15. Applicant’s Skills: Describe any specialized training, apprenticeship, skills and extra-curricular

16. Please list all equipment operating experience you have?

17. References: List any two people who would be willing to provide a reference for you

18. Specialized Skills

Applicant’s Statement

I certify that the answers given here are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at anytime and the Employer may discharge Employee at any time, with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless an authorized executive of this organization specifically acknowledges such change in writing.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

* Word Verification:
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