Employment Application

Notice to Applicants: Federal and state law requires that all applications be considered without regard to race, religion, color, sex, age or natural origin. We believe in and fully support the principle of equal employment opportunity and will fulfill our obligation to the fullest.


Name: (required)

Email address: (will be used only to send a copy of this application)

Present address: (required)

How long have you lived at present address?

Telephone number: (required)

Previous address:

How long did you live there?

Drivers license number:

Position(s) applying for:

Rate of pay expected:

How did you hear of this opening?

Have you worked with us before? YesNo
If yes, when/how long?

Previous job:

Reason for leaving:

Sex: MaleFemale

Have you been convicted of a felony? YesNo
For what?

From the position(s) applied for above, or any positions relative to such, are their any pre-existing health or physical conditions that prevent you from performing these functions or duties?

Do you presently hold a Class A or B truck license? YesNo
If yes, indicate which one and for how long:


Past Employment

List in reverse order beginning with present employer.

Employer 1

Company:

Address:

Position/job/title:

Dates:
From To

Wage/Salary:
Beginning: Ending

Reason for leaving:

Contact:

May we contact the employer at the phone given? YesNo

Employer 2

Company:

Address:

Position/job/title:

Dates:
From To

Wage/Salary:
Beginning: Ending

Reason for leaving:

Contact:

May we contact the employer at the phone given? YesNo

Personal References

Name Address Relationship Phone number

Additional Information

If you would like to submit your résumé or any related files, please email them to assuredasphalt@gmail.com


Terms & Conditions

By submitting this employment application, you agree to the following:
The information provided by me in this application for employment is true and complete to the best of my knowledge. I understand that if I am employed, any false statements will be considered as cause for possible dismissal. You are hereby authorized to conduct an investigation of my personal history and/or credit and financial records employing investigative or credit agencies or bureaus of your choice, subject to the provisions of the Fair Credit Reporting Act.

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