Employment Application

Today's date:

Will you consent to a drug test?

Yes

No

Will you consent to a background check?

Yes

No

Full name

Address

City, State

Phone number

Alternate phone number

Email

Free Text

_________________________________________

What kind of work are you applying for?

How many years of experience do you have doing dirt work?

None

0-2

3-5

6-10

over 10

What types of machinery can you operate?

Are you 18 years or older?

Yes

No

Are you a U.S. citizen or an alien authorized to work in the United States?

Yes

No

Do you have a valid Driver's License?

Yes

No

If yes, issued in what state?

Drivers License #

Have you ever been convicted of a felony or misdemeanor within the last 5 years?

Yes

No

If so, describe

Free Text

_________________________________________

EDUCATION

1. High School Attended

# Years Attended

Location of High School (city,state)

Course(s)

Did you graduate?

Yes

No

2. College attended

# Years attended

Location (city, state)

Course(s)

Did you graduate?

Yes

No

3. Technical/Trade school attended

# Years attended

Location (city, state)

Course(s)

Did you graduate?

Yes

No

Free Text

__________________________________________

EMPLOYMENT HISTORY

1. Most recent employer

Start date

End date

Type of work performed

Starting salary

Final salary

Reason for leaving?

2. Employer

Start date

End date

Type of work performed

Starting salary

Final salary

Reason for leaving?

3. Employer

Start date

End date

Type of work performed

Starting salary

Final salary

Reason for leaving?

4. Employer

Start date

End date

Type of work performed.

Starting salary

Final salary

Reason for leaving?

5. Employer

Start date

End date

Type of work performed.

Starting salary

Final salary

Reason for leaving?

6. Employer

Start date

End date

Type of work performed.

Starting salary

Final salary

Reason for leaving?

Free Text

__________________________________________

Free Text

PERSONAL REFERENCES

Name

Daytime phone number

Occupation/Relationship

Name

Daytime phone number

Occupation/Relationship

Name

Daytime phone number

Occupation/Relationship

Free Text

List 3 qualities about yourself that will help make you a productive and valuable employee:

1.

2.

3.

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Employment Application

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