Application of Employment - Cottle's Asphalt Maintenance Inc

Name *

First

Last

Phone *

Email *

Address *

Have you ever been employed here before? *

If "Yes", please give dates and position(s):

If under the age of 18, and it is required, can you furnish a work permit? *

If "No", please explain:

Are you legally eligible for employment in this country? *

(IF HIRED, PROOF OF CITIZENSHIP WILL BE REQUIRED WITHIN 3 DAYS OF START DATE)

Type of employment desired: *

Full-Time
Part-Time
Temporary/Seasonal
Educational Co-Op

Date available for work *

Have you ever pled "guilty" or "no contest" to, or been convicted of a crime? *

If "Yes", please provide date(s) and details

*Answering "YES" to these questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

Do you currently possess a valid driver's license? *

If you have previous construction employment, what have you done and where have you worked? List approximate years of prior employment for each.

Skills, Qualifications, Equipment You Have Experience Operating

Summarize any additional training & skills. Include licenses & certificates that relate to the functions of the position for which you are applying.

Educational Background

**High School, College, Other. Please list Name, Location, years completed, and if graduated. Also, list course of study.

References (give the names of four references who are non-related)

**Please list Name, Relationship, Telephone, and # of Years Known

EMERGENCY CONTACT(s)

RELATIONSHIP

TELEPHONE #

APPLICANT STATEMENT

I hereby declare the information provided by me in this application is true and complete, and I understand that falsification of this information is grounds for refusal to hire or, if I've been hired, for termination. I authorize any of the persons or organizations referenced in this application to give you and any of them all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from liability for any damage which may result from furnishing such information to you. I further acknowledge that if the employer employs me, my employment will be "at-will", and may be terminated with or without cause at any time by me or by Cottle's Asphalt Maintenance, Inc. I understand that no representative of the company has any authority to enter into any agreement for employment for any specified period of time or to assure any benefits or terms and conditions of employment, either prior to commencement of the employment or after I have become employed. I consent to a drug test, either prior to commencement of employment or after I become employed, if deemed necessary by the employer.

Name *

First

Last

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Numbers

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8:00 AM - 4:30 PM