Job Application: Construction Laborer/Equipment Operator

Title: Construction Laborer/Equipment Operator

Fields marked with an asterisk (*) must be filled out before submitting.

Personal Information

Full Name (first, MI, last) *
Social Security Number
Present Address (street, city, state, zip) *
Permanent Address (street, city, state, zip)
Phone Number *
Cell Phone Number
Email Address *
Are you 18 or Older? * Yes
No

Employment Desired

Position
Date you can start
Desired Salary
Are you employed now? * Yes
No
May we contact your current employer? * Yes
No
Unemployed
Are you able to work * Full Time
Part Time
Temporary
What is your military status?
Can you travel if job requires? * Yes
No
Possibly
If Possibly, explain

Drivers License

Do you have a valid Drivers License? * Yes
No
DL # *
Expires *
Class * Class A
Class B
Class C
Have you had a motor vehicle accident or moving violation in the past 3 years? * Yes
No
If yes, explain

Education

Highschool

Name and Location of School *
Years attended *
Graduate? * Yes
No
Subjects Studied

College

Name and Location of School
Years attended
Graduate? Yes
No
Subjects Studied

Trade School

Name and Location of School
Years attended
Graduate? Yes
No
Subjects Studied

The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.

Trade Experience & Expertise

What type of Experience do you have? Be Specific. *
List types and models of equipment you are competent at operating. Be Specific. *
How many years experience do you have operating this equipment? *

Former Employers

Employer 1

Name and Address of Employer *
Start/End Dates *
Supervisor
Salary
Position *
Reason for Leaving *

Employer 2

Name and Address of Employer *
Start/End Dates *
Supervisor
Salary
Position *
Reason for Leaving *

Employer 3

Name and Address of Employer *
Start/End Dates *
Supervisor
Salary
Position *
Reason for Leaving *

References

Give the name of three persons not related to you, whom you have known for at least a year.

Reference 1

Name
Business
Phone #
Years Acquainted

Reference 2

Name
Business
Phone #
Years Acquainted

Reference 3

Name
Business
Phone #
Years Acquainted

Physical Record

Do you have any physical limitations that preclude you from performing any work for which you are being considered? Yes
No
If YES, what can be done to accommodate these limitations?

In case of emergency, please contact….

Name
Phone Number
Address
 

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on the application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice.”

Signature *
Date *