Quality Construction Services
Since 1982
10/11/08 last updated
Quality Construction Services Since 1982 10/11/08 last updated |
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Please fill this application and fax to us or copy and paste in an email Attention: Dispatch NIXCAVATING INC.
1821
Boston Avenue * PO Box 2232 Longmont,
CO 80501 Phone (303) 776-8898 Fax (303) 776-8669
www.nixcavating.com info@nixcavating.com EMPLOYMENT APPLICATION
TODAY’S DATE:______________ Asking Wage____________
Starting Wage__________ NAME:___________________________________________________________________________________
LAST
FIRST
M.I. SOCIAL SECURITY
NUMBER:______________________________________________________________
HOME
PHONE:______________________________CELL
PHONE:________________________________ CURRENT
ADDRESS:______________________________________________________________________
STREET
______________________________________________________________________
CITY
STATE
ZIP PRIOR ADDRESS:
______________________________________________________________________
STREET
______________________________________________________________________
CITY
STATE
ZIP CURRENT DRIVERS LICENSE
#:___________________________ STATE OF ISSUE:________________ CDL
YES_____NO_____ Endorsements for
__________________________________________________ CITIZEN USA
YES_______ NO_______
MALE:_________ FEMALE:_________ POSITION APPLYING
FOR:_________________________________________________________________ EXPERIENCE:_____________________________________________________________________________
_____________________________________________________________________________ DO YOU HAVE OR HAVE YOU EVER HAD ANY INJURIES,
OR ILLNESSES THAT HAVE RESULTED IN HOSPITALIZATION, SURGERY, OR LOST WORK TIME?
Yes ________ No ________ IF YES, PLEASE EXPLAIN
_________________________________________________________________ __________________________________________________________________________________________ IN CASE OF EMERGENCY
CONTACT:_______________________________________________________
NAME
PHONE PREVIOUS EMPLOYERS: MOST RECENT EMPLOYER __Yes
__No
Are you currently working for this employer? If yes, may we contact?
__________________________________________________________________________________________________
COMPANY
NAME CITY
STATE
FROM_____________TO____________
________________________ DATES
EMPLOYED
JOB TITLE SUPERVISOR
NAME
__________________________________________________________________________________________ DUTIES
_____________PER_____________
_____________________________________________ SALARY (HOUR, WEEK, MONTH)
REASON FOR LEAVING
SECOND MOST RECENT EMPLOYER
Phone (
) ____________________________________
_____________________
____________
Fax
(
) COMPANY
NAME
CITY
STATE
FROM_____________TO____________
__________________ ________________________ DATES
EMPLOYED
JOB TITLE
SUPERVISOR NAME
__________________________________________________________________________________________ DUTIES
_____________PER_____________
__________________________________________________________ SALARY (HOUR, WEEK, MONTH)
REASON FOR LEAVING
THIRD MOST RECENT EMPLOYER
Phone (
) ________________________________
_____________________________ _______ Fax
(
) COMPANY
NAME CITY
STATE
FROM_____________TO____________
__________________ __________________________ DATES
EMPLOYED
JOB TITLE
SUPERVISOR NAME
__________________________________________________________________________________________ DUTIES
_____________PER_____________
__________________________________________________________ SALARY (HOUR, WEEK, MONTH)
REASON FOR LEAVING
CERTIFICATE AND RELEASE: I certify that the
answers given by me to the foregoing questions and the statements made by me are
complete and true to the best of my knowledge and belief.
I understand that any false information, omissions or misrepresentations
of facts called for in this application, whether on this document or not, may
result in rejections of my application or discharge at any time during my
employment. I authorize the company
and / or its agents, including consumer reporting bureaus, to verify any of this
information. I authorize all former employers, persons, schools, companies
and law enforcement authorities to release any information concerning my
background and hereby release any said persons, schools, companies and law
enforcement authorities from any liability for any damage whatsoever for issuing
this information. I also understand
that the use of illegal drugs is prohibited during employment. Company policy requires testing, I am willing to submit to
drug testing to detect the use of illegal drugs prior to and during employment. _________________ _______SIGNATURE DATE
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