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Application For Employment

Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, handicap or veteran status. To the Applicant: We appreciate your interest in our Company and assure you that we are interested in your qualifications. A clear understanding of your background and work history will aid us in seeking to place you in a position which, in our judgment, best meets your qualifications.
Personal:
Company you are applying to (cut and past either The Pavement Company, Hart Pavement Striping, Midwest Pavement Contracting):
Last Name First Middle Street Address Home Telephone City State Zip Business Telephone
Social Security Number
Have you ever applied for employment with us?     Yes     No
If yes: Month Year Location -- choose -- January February March April May June July August September October November December
Position Desired	Pay Expected
Apart from absence for religious observance, are you available for full-time work?     Yes     No
If not, what hours can you work?
Will you work overtime if asked?     Yes     No
Are you legally eligible for employment in the United States?     Yes     No
When will you be available to begin work?
Other special training or skills (languages, machine operation, etc.)
If employed and under the age of 18, can you furnish a work permit?     Yes     No
Can you travel if the job requires it?     Yes     No
Have you been convicted of a felony in the last 7 years?     Yes     No
If yes, please explain:
Have you ever filed for workman's compensation?     Yes     No
If yes, please explain:
Have you ever filed for unemployment?     Yes     No
If yes, please explain:
Would you object to drug testing?     Yes     No
Would you object to a lie detector test?     Yes     No
Employment:
Please give accurate, complete full-time and part-time employment records. Start with your present or most recent employer.
1. Company Name Telephone Address Starting Date of Employment Ending Date of Employment Month Year Month Year -- choose -- January February March April May June July August September October November December -- choose -- January February March April May June July August September October November December Name of Supervisor Weekly Pay Starting     Ending     Job Title Description of Work Reason For Leaving
2. Company Name Telephone Address Starting Date of Employment Ending Date of Employment Month Year Month Year -- choose -- January February March April May June July August September October November December -- choose -- January February March April May June July August September October November December Name of Supervisor Weekly Pay Starting     Ending     Job Title Description of Work Reason For Leaving
Education:
School Name and Location of School Course of study No. of years completed Did you graduate? Degree or Diploma Graduate 0 1 2 3 4 5 6 7 8 9 10 10+ yes no College 0 1 2 3 4 5 6 7 8 9 10 10+ yes no Business | Trade 0 1 2 3 4 5 6 7 8 9 10 10+ yes no Technical 0 1 2 3 4 5 6 7 8 9 10 10+ yes no High School 0 1 2 3 4 5 6 7 8 9 10 10+ yes no Elementary 0 1 2 3 4 5 6 7 8 9 10 10+ yes no
Authorization and Understanding:
By signing this application, I agree that all of the information now or later given by me in support of my application for employment is true and complete. I give you my permission to verify any of the information concerning my employment, education, credit, or medical history with the appropriate individuals, organizations, or governmental bodies. I give these individuals, organizations, and governmental bodies my permission to release any of the information that you need, including my disciplinary record, without requiring them to contact me, or give me written notice before revealing the information to you. By signing this application, I release you and them from any liability whatsoever arising out of any information request or disclosure. I agree that any false information in support of my application may subject me to discharge at any time during my employment. If hired, I agree I will serve at the will of the Company, and I agree that I shall be bound by the rules, policies, regulations, and terms and conditions of employment of the company as they are from time to time changed with or without notice to me. I AGREE THAT EITHER PARTY MAY TERMINATE THE EMPLOYMENT RELATIONSHIP, WITH OR WITHOUT CAUSE, AT ANY TIME. I agree that these arrangements may only be altered in writing, directed to me personally, by the President of the Company. I further agree that my employment is conditional upon satisfactory completion of documentation as required by the Immigration Reform and Contract Act of 1986, and until such time as the results of my pre-employment physical (if such physical is required) are known.
Agree Disagree	Signature of Applicant (please enter your full name):