SRM Contracting & Paving

Employment Application

An Equal Opportunity Employer

Personal

First name:

Last name:

Middle Initial:
 

Address:

City: State: Zip Code:

Email Address:

Home Phone No.

Celluar Phone No.

Other Phone No.

If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?

YES NO

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

YES NO

General Information

Position Desired: Desired Salary :$ Date Available:  

How did you hear about us? (Referral):

If referred by employee, newspaper, or other, please specify:

Work History

May we contact your present employer? YES NO

*Fill in as many past employers as possible

Company

Address

Supervisor

Phone

Position:

Duties:

Dates:

From: To:

Salary:

Start: Finish:

Reason For Leaving:

Company

Address

Supervisor

Phone

Position:

Duties:

Dates:

From: To:

Salary:

Start: Finish:

Reason For Leaving:

Company

Address

Supervisor

Phone

Position:

Duties:

Dates:

From: To:

Salary:

Start: Finish:

Reason For Leaving:

Company

Address

Supervisor

Phone

Position:

Duties:

Dates:

From: To:

Salary:

Start: Finish:

Reason For Leaving:

Company

Address

Supervisor

Phone

Position:

Duties:

Dates:

From: To:

Salary:

Start: Finish:

Reason For Leaving:

Company

Address

Supervisor

Phone

Position:

Duties:

Dates:

From: To:

Salary:

Start: Finish:

Reason For Leaving:

 

Have you ever been convicted of a criminal offense (felony or serious misdomeanor)? YES NO

If yes, state the nature of the crime(s), when and where convicted and disposition of case:

*No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position applied for may, however, be considered.
 
Military Service
 

Have you obtained any special skills or abilities as a result of service in the military? YES NO

If So, Describe:

 
Education
 
Type of School Name of School & Location Major Course Studied Choose Highest Year Completed Degree/Diploma
High School


College

Business
Other
 

Additional Remarks:

 

 

PLEASE READ CAREFULLY

SRM Contracting & Paving is an Equal Opportunity Employer and does not discriminate in hiring on the the basis of race, color, national origin, sex, age, disability, verteran status, or any other basis prohibited by federal, state or local ordinance. The information contained in this employment application will be used solely to determine your qualifications for the position for which you applied.

I authorize investigation of all statements contained in this application. I understand that falsification, misrepresentation or omission of facts called will result in immediate dismissal or removal of my application from consideration. I authorize SRM Contracting & Paving to secure information about my experience with former employers, educational institutions and agencies, and for those parties to provide information concerning my experience, releasing all parties from liability.

I agree that should I be offered employment by SRM Contracting & Paving, I will submit to a post-offering urinalysis test for the purpose of detecting illegal drugs and/or alcohol. My failure to cooperate will result in being removed from consideration for employment. I also understand that any offers for employment will be withdrawn if illegal drugs and/or alcohol are detected through testing.

SRM Contracting & Paving is an at-will employer, which means the employee, or SRM Contracting & Paving may terminate my employment for any reason at any time, with or without cause.

I CERTIFY THAT I HAVE READ AND UNDERSTOOD THE FOREGOING AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, THE INFORMATION ON THIS FORM IS TRUE AND CORRECT.

SIGNED x                      DATE: 

 
 

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