Position(s) Applied For:

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Relative Inquiry Other

First name:
Middle name:
Last name:
Address:
City:		State:
Zip:		Telephone:

Social Security Number (optional):
Best time to contact you at home is:

If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No

Have you ever filed an application with us before?
Yes: No

Have you ever been employed with us before?
Yes: No

Do any of your friends or relatives, other than spouse, work here?
Yes: No

Are you currently employed? Yes No

May we contact your present employer? Yes No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Yes No
Proof of citizenship or immigration status will be required upon employment.

Date available for work:
What is your desired salary range?

Are you available to work:
Full Time
      Please indicate 1 2 3 shift
Part Time
       Please indicate Mornings Afternoon Evenings
Temporary
       Please indicate dates available -

Are you currently on "lay-off" status and subject to recall?
Yes No

Can you travel if a job requires it?
Yes No

Do you have a current valid driver's license?
Yes No

CDL (commercial driver's license)?
Yes No

Education

High School
Name:
Address:
City: State: ZIP:
Course of study:
Years completed: Diploma/Degree:

Undergraduate College
Name:
Address:
City: State: ZIP:
Course of study:
Years completed: Diploma/Degree:

Graduate/Professional
Name:
Address:
City: State: ZIP:
Course of study:
Years completed: Diploma/Degree:

Other (Specify: )
Name:
Address:
City: State: ZIP:
Course of study:
Years completed: Diploma/Degree:

Work Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer:
Address:
Telephone:
Starting/Present Job Title:
Supervisor:
Reason for leaving:
Dates employed: to

Hourly Rate/Salary:
     Starting:      Final:

Work performed:

May we contact: Yes No

Employer:
Address:
Telephone:
Starting/Present Job Title:
Supervisor:
Reason for leaving:
Dates employed: to

Hourly Rate/Salary:
     Starting:      Final:

Work performed:

May we contact: Yes No

Employer:
Address:
Telephone:
Starting/Present Job Title:
Supervisor:
Reason for leaving:
Dates employed: to

Hourly Rate/Salary:
     Starting:      Final:

Work performed:

May we contact: Yes No

Employer:
Address:
Telephone:
Starting/Present Job Title:
Supervisor:
Reason for leaving:
Dates employed: to

Hourly Rate/Salary:
     Starting:      Final:

Work performed:

May we contact: Yes No

Comments: Include explanation of any gaps in employment.

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

Describe any job-related training received in the United States military.

List professional, trade, business or civic activities and offices held.
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status!

Additional Information
Other qualifications: Summarize special job-related skills and qualifications acquired from employment or other experience.

Specialized Skills (Skills/Equipment Operated)

Dozer
Backhoe
Splicer
Cable locator
Lineman

Production/Mobile Machinery (list):

Other (list):

State any additional information you feel may be helpful to us in considering your application.

Note to Applicants:
Do not answer this question unless you have been informed about the requirements of the job for which you are applying.

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? A review of the activities involved in such a job or occupation has been given.
Yes No

Personal/Professional References
Do not include family members.

Name:
Phone number:
Best time to call: Occupation:

Name:
Phone number:
Best time to call: Occupation:

Name:
Phone number:
Best time to call: Occupation:

Applicant's Statement
I certify that answers given herein are true and complete.

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 any time 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 such change is specifically acknowledged in writing by an authorized executive of this organization.

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.

Agree Disagree