Job Application: Construction Laborer/Equipment Operator Title: Construction Laborer/Equipment OperatorFields marked with an asterisk (*) must be filled out before submitting.Personal InformationFull Name (first, MI, last) *Social Security NumberPresent Address (street, city, state, zip) * Permanent Address (street, city, state, zip) Phone Number *Cell Phone NumberEmail Address *Are you 18 or Older? * Yes NoEmployment DesiredPositionDate you can start Desired SalaryAre you employed now? * Yes NoMay we contact your current employer? * Yes No UnemployedAre you able to work * Full Time Part Time TemporaryWhat is your military status? Can you travel if job requires? * Yes No PossiblyIf Possibly, explain Drivers LicenseDo you have a valid Drivers License? * Yes NoDL # *Expires * Class * Class A Class B Class C Have you had a motor vehicle accident or moving violation in the past 3 years? * Yes NoIf yes, explain EducationHighschoolName and Location of School *Years attended *Graduate? * Yes NoSubjects StudiedCollegeName and Location of SchoolYears attendedGraduate? Yes NoSubjects StudiedTrade SchoolName and Location of SchoolYears attendedGraduate? Yes NoSubjects StudiedThe 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 & ExpertiseWhat 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 EmployersEmployer 1Name and Address of Employer * Start/End Dates *SupervisorSalaryPosition *Reason for Leaving * Employer 2Name and Address of Employer * Start/End Dates *SupervisorSalaryPosition *Reason for Leaving * Employer 3Name and Address of Employer * Start/End Dates *SupervisorSalaryPosition *Reason for Leaving * ReferencesGive the name of three persons not related to you, whom you have known for at least a year.Reference 1NameBusiness Phone #Years AcquaintedReference 2NameBusinessPhone #Years AcquaintedReference 3NameBusinessPhone #Years AcquaintedPhysical RecordDo you have any physical limitations that preclude you from performing any work for which you are being considered? Yes NoIf YES, what can be done to accommodate these limitations? In case of emergency, please contact….NamePhone NumberAddress “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 *