First Name
Middle Initial
Street Address
City
State
Zip Code
Driver's License Number
State of Driver's License
Home Phone Number
Type of work desired
Indicate Position Applied For
Are you willing to travel outside this area to work?
Are you 18 or over?
Have you ever been convicted of a violation of law other than a minor traffic violation?
If yes, please explain (Note: A conviction record is not an automatic bar to employment. Each case is considered in relation to position applied.)
EMPLOYMENT RECORD
Employer (Present or most recent)
Street Address
City
State
Zip Code
Dates of Employment (Month, Year)
From:
To:
Description of Duties
Position Title
Specific Duties
Reason for Job Change
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Employer
Street Address
City
State
Zip Code
Dates of Employment (Month, Year)
From:
To:
Description of Duties
Position Title
Specific Duties
Reason for Job Change
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Employer
Street Address
City
State
Zip Code
Dates of Employment (Month, Year)
From:
To:
Description of Duties
Position Title
Specific Duties
Reason for Job Change
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Employer
Street Address
City
State
Zip Code
Dates of Employment (Month, Year)
From:
To:
Description of Duties
Position Title
Specific Duties
Reason for Job Change
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Skills & Other Employment History:
List other employment and skills, talents, or experience which may qualify you for employment.
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APPLICATION ARE KEPT ON FILE FOR 90 DAYS ONLY
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Applicant Statement
I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references, employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering, and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations, or organizations for furnishing such information about me.
I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by state or federal law.
If I am hired, I understand that I am free to resign at any time with or without cause and with or without prior notice, except as may be required by law. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and federal immigration laws require me to complete an I-9 Form in this regard.
Please open and read the following forms: Your digital signature verifies that you agree to all terms.
Essential Functions of Construction Laborers & Equipment Operators
Company Drug-Free Workplace Policy
I have read and I am aware of the physical requirements that may be required of me at Adams Construction Co at any time during my employment.
All potential new hires will be subject to a pre-employment drug test. All employees of Adams Construction Co will participate in the company's random drug and alcohol testing program.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Enter your full name and date below. By entering your name below you are entering the equivalent to your signature and verification.
Signature (Enter full name)
Date: