Job Application

Position Applying For*

Date Available to Start

General

First Name*

Middle Name

Last Name*

Present Street Address*

City*

State*

Zip Code

Phone*

Email*

Are you 18 years of age or older?*

Yes

(If you are hired, you may be required to submit proof of age.)

If hired, you will be required to furnish proof of your eligibility to work in the U.S.

Have you ever applied here before?*

Yes

If yes, when?

Were you ever employed here?*

Yes

If yes, when?

Do you have any relatives employed at Anderson Western?*

Yes

If yes, when and who?

Are you willing to travel and work out of town if the job requires it?*

Yes

If employed, do you expect to be engaged in any additional business or employment outside of our job?*

Yes

If yes, give details

Construction work requires strenuous physical activity, such as: climbing several flights of stairs or ladders uninterrupted, working at height, lifting at least 50 pounds, repetitive lifting, working 40 to 60 hours per week, and other activities. Are you able to perform these tasks with or without accommodation?*

Yes

Education

What Level Of Education Have You Completed?

High School

College or University

Vocational or Technical

High School or GED*

Number of Years Completed*

Diploma/ Degree/ Certificate*

College or University

Number of Years Completed

Diploma/ Degree/ Certificate

College/University Subjects Studied

Vocational or Technical

Number of Years Completed

Diploma/ Degree/ Certificate

Vocational or Technical Subjects Studied

Special Skills

What skills or additional training do you have that are related to the job for which you are applying?

What types and makes/models of construction equipment can you operate or repair? Please give a brief description of types of work you have done on each, e.g. blade/finish and rough grade, dozer/stockpiling?

Do you have a valid driver’s license?*

Yes

Do you have reliable transportation to and from work?*

Yes

Driver’s License Number

Class of License

State Licensed In

CDL*

Yes

Multi-Trailer*

Yes

Hazardous*

Yes

Tanker*

Yes

Air Brake*

Yes

Have you had your driver’s license suspended or revoked in the last 3 years?*

Yes

If yes, give details

List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability, genetic information or other protected status.)

Work History

List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references.

First Employer Information

Name, Address and Telephone of Employer

Job Title

Supervisor(s)

Duties

Start Date

End Date

Reason for leaving

Second Employer Information

Name, Address and Telephone of Employer

Job Title

Supervisor(s)

Duties

Start Date

End Date

Reason for leaving

Third Employer Information

Name, Address and Telephone of Employer

Job Title

Supervisor(s)

Duties

Start Date

End Date

Reason for leaving

References

A job offer may be contingent upon acceptable references from current and former employers.

Have you worked or attended school under any other names?*

Yes

If yes, give names

Are you presently employed?*

Yes

If yes, whom do you suggest we contact?

Have you ever been fired from a job or asked to resign?*

Yes

If yes, please explain?

Affidavit, Consent And Release

Please Read Each Statement Carefully

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers, and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.

I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE, EXPRESS OR IMPLY CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE PRESIDENT OF THE ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE PRESIDENT AND THE EMPLOYEE. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE.

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Name

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General

Education

Special Skills

Work History

First Employer Information

Second Employer Information

Third Employer Information

References

Affidavit, Consent And Release

Call Or Fax

Mail or Visit

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