Application For Employment

"*" indicates required fields

Instructions for completing this application:

Each question should be fully and accurately answered.

No action will be taken on the application until all questions have been answered.

This application will remain active for ninety (90) days only. If you wish to be considered for employment thereafter, you must submit another Application for Employment.

This company is an Equal Opportunity Employer. Federal and state law prohibits discrimination in employment practices and we do not discriminate on the basis of race, color, religion, sex, age, national origin, disability, marital or veteran status, or any other legally protected status.

False statements on this application shall be sufficient cause for termination.

Hazard Construction Company is committed to a safe, healthy work environment. Applicants and employees will be required to pass a physical abilities test including drug screening.

If hired, can you submit verification of your legal right to work in the United States?*

Yes

Personal Information

Name*

First Middle Last

Address*

Street Address City State Zip Code Country

Home Phone Number

Cell Phone Number*

E-Mail Address*

Employment Desired
Please check one:

Employment Options*

Administrative Staff

Superintendent

Foreman

Engineer

Estimator

Laborer

Equipment Operator

Other

If Other, please list position here:

How did you hear about this position?

Newspaper

Walk-In

Internet

Friend

Relative

Please name Internet Site/Friend/Relative

Date Available for Work (mm/dd/yyyy)*

Salary requirements*

Indicate the hours you are available to work*

Days

Evenings

Nights

Indicate the days you are available to work*

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Additional Information

Were you ever employed by Hazard Construction Company?*

Yes

If yes, when?

Do you have any relatives employed by Hazard Construction Company?*

Yes

If yes, Name

Relationship

Have you ever been fired from a job or asked to resign?*

Yes

If yes, please explain

List any languages other than English that you speak, read or write that could be of benefit:

Language 1

Speak

Fluent

Good

Fair

Read

Fluent

Good

Fair

Write

Fluent

Good

Fair

Language 2

Speak

Fluent

Good

Fair

Read

Fluent

Good

Fair

Write

Fluent

Good

Fair

Language 3

Speak

Fluent

Good

Fair

Read

Fluent

Good

Fair

Write

Fluent

Good

Fair

Have you ever been in the U.S. Military?*

Yes

Are you now a member of the National Guard/Reserves?*

Yes

If you are under 18 years of age, can you provide proof of your eligibility to work?*

Yes

N/A

If hired, can you provide proof of U.S. citizenship or proof of your legal right to work in he U.S.?*

Yes

Are you able to perform all of the essential functions of the job for which you are applying with or without reasonable accommodation? Human Resources will provide a full description of the essential functions of the position.*

Yes

If hired, are there any accommodations Hazard Construction Company would need to provide so that you can perform all essential functions of the position?*

Yes

If yes, please explain:

If hired for a position requiring driving, are you willing to submit your DMV record?*

Yes

N/A

Have you completed an Apprenticeship Program?*

Yes

If yes, what craft?

Employment History

List below all present and past employers over the past ten years, starting with your most recent employer. Account for all periods of unemployment.

You must complete this section even if attaching a resume.

Are you currently on "lay off" status & subject to a recall?*

Yes

May we contact your current employer?

Yes

Current Employer

Name

Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Address

Street Address City State Zip Code

Phone Number

Supervisor(s)

Job Positions

Reason(s) for Leaving

List Essential Job Functions

Previous Employer 1

Name

Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Address

Street Address City State Zip Code

Phone Number

Supervisor(s)

Job Positions

Reason(s) for Leaving

List Essential Job Functions

Previous Employer 2

Name

Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Address

Street Address City State Zip Code

Phone Number

Supervisor(s)

Job Positions

Reason(s) for Leaving

List Essential Job Functions

Previous Employer 3

Name

Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Address

Street Address City State Zip Code

Phone Number

Supervisor(s)

Job Positions

Reason(s) for Leaving

List Essential Job Functions

Previous Employer 4

Name

Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Address

Street Address City State Zip Code

Phone Number

Job Positions

Supervisor(s)

Reason(s) for Leaving

List Essential Job Functions

Education

High School (grades completed)

High School Name

City

State

College (years completed)

College/University Name

City

State

Certification and Training

CPR / First Aid

License or Certification Number

Date Licensed or Certified (mm/dd/yyyy)

Date License or Certification Expires (mm/dd/yyyy)

Agency or Location Issuing License or Certification

Commercial License

License or Certification Number

Date Licensed or Certified (mm/dd/yyyy)

Date License or Certification Expires (mm/dd/yyyy)

Agency or Location Issuing License or Certification

Specialized Training

Training Description

License or Certification Number

Date Licensed or Certified (mm/dd/yyyy)

Date License or Certification Expires (mm/dd/yyyy)

Agency or Location Issuing License or Certification

Other

Training Description

License or Certification Number

Date Licensed or Certified (mm/dd/yyyy)

Date License or Certification Expires (mm/dd/yyyy)

Agency or Location Issuing License or Certification

Other

Training Description

License or Certification Number

Date Licensed or Certified (mm/dd/yyyy)

Date License or Certification Expires (mm/dd/yyyy)

Agency or Location Issuing License or Certification

Other

Training Description

License or Certification Number

Date Licensed or Certified (mm/dd/yyyy)

Date License or Certification Expires (mm/dd/yyyy)

Agency or Location Issuing License or Certification

References

NOTE: Hazard Construction Company will not contact a potential employee's provided references until an offer of employment has been extended and accepted.

List below three persons not related to you who have knowledge of your professional work performance:

Professional Reference #1

Name

First Last

Occupation

Address

Street Address City State Zip Code

Phone Number

Company Name

E-Mail Address

Relationship

Years Acquainted

Professional Reference #2

Name

First Last

Occupation

Address

Street Address City State Zip Code

Phone Number

Company Name

E-Mail Address

Relationship

Years Acquainted

Professional Reference #3

Name

First Last

Occupation

Address

Street Address City State Zip Code

Phone Number

Company Name

E-Mail Address

Relationship

Years Acquainted

Reference Check Authorization

I hereby authorize my former employer to release any and all references and records related to my past employment and work history to Hazard Construction Company, Attn: Human Resources Department. I release and discharge both my former and prospective employers from any and all claims of actions related to the Employee Reference Request and any related exchange of records or other communications concerning my past employment.

Applicant Printed Name*

First Middle Last

Applicant Signature*

Date*

Application Certification

I certify that answers given are true and complete to the best of my knowledge and contain no material omission of any kind.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision

I understand that false or misleading information given in my application, interview(s) or material omissions may disqualify me from employment or result in my discharge. I release Hazard Construction Company, its employees and agents, from any and all liability for failing to hire me or terminating my employment due to such false information or material omissions. I also understand that I am required to abide by all rules and regulations of the Company.

I understand and agree that if I am hired; my employment relationship with Hazard Construction Company is at will, which means that it may be terminated at any time, with or without cause or advance notice, either by me or Hazard Construction Company. In addition, if I am hired, Hazard Construction Company will have the right to impose discipline or alter my position at its discretion. I understand and agree that no representative of Hazard Construction Company may enter into any agreement contrary to the foregoing unless in express written consent signed by the President of Hazard Construction Company.

I understand and agree that any offer of employment is contingent upon successfully completing and passing a drug and alcohol screening, medication examination, and physical abilities test based on the specific physical requirements of the position to which I am offered.

Signature*

Date*

APPLICATION FOR EMPLOYMENT

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