Employment – Clark & Sons Contracting

Clark and Sons Contracting Corporation

PERSONAL INFORMATION

Position Applied For *

Date *

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Email *

Are you eligible to work in the United States? *

Yes
No

If you are under age 18, do you have an employment/age certificates?

Yes
No

Have you been convicted of or pleaded no contest to a felony within the last seven years? *

Yes
No

If yes, please explain:

Hours Available From *

What date are you available to start work? *

If hired, would you have a reliable means of transportation to and from work? *

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? *

If no, describe the functions that cannot be performed.

(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.)

EDUCATION

Name and Address of School - Degree/Diploma *

Skills and Qualifications: Licenses, Skills, Training, Awards *

MACHINERY EXPERIENCE & TRAINING

Scraper: *

Yes
No

Years of Experience: *

What type of Experience: *

Skip Loader: *

Yes
No

Years of Experience: *

What type of Experience: *

Water Truck: *

Yes
No

Years of Experience: *

What type of Experience: *

Loader: *

Yes
No

Years of Experience: *

What type of Experience: *

Blade: *

Yes
No

Years of Experience: *

What type of Experience: *

Dozer: *

Yes
No

Years of Experience: *

What type of Experience: *

Grade Checker: *

Yes
No

Years of Experience: *

What type of Experience: *

EMPLOYMENT HISTORY

Present or Last Position

Present or Last Employer

Supervisor

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Email

Position Title

Datest Worked: From/To

Responsibilities

Reason for Leaving

Present or Last Position

Present or Last Employer

Supervisor

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Email

Position Title

Datest Worked: From/To

Responsibilities

Reason for Leaving

Present or Last Position

Present or Last Employer

Supervisor

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Email

Position Title

Datest Worked: From/To

Responsibilities

Reason for Leaving

May We Contact Your Present Employer? *

Yes
No

Business References (3)

Name/Title - Address - Phone

AUTHORIZATION

Initials *

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for

Initials *

I hereby authorize to thoroughly investigate my references, work record, education and other matters related to my suitability for employment unless otherwise specified above. I further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

Initials *

I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company's designated representative.

Initials *

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire

By typing my initials above and my name below, I am electronically signing my application. *

NAME *

First

Middle

Last

Clark and Sons Contracting Corporation

PERSONAL INFORMATION

EDUCATION

MACHINERY EXPERIENCE & TRAINING

EMPLOYMENT HISTORY

Present or Last Position

Present or Last Position

Present or Last Position

Business References (3)

AUTHORIZATION

Clark & Sons Contracting Corporation