EMPLOYMENT

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Application For Employment

PERSONAL INFORMATION

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Name

First Name

Last Name

Present Address

APT. No.

City

State

ZIP

Permanent Address

APT. No.

City

State

ZIP

Previous Address If Less Than 3 Years

APT. No.

City

State

ZIP

Phone #

Cell Phone #

Are You 18 Years or Older?

Yes

Are You Legally Authorized to Work in the US?

Yes

Emergency Contact (Name)

(Phone)

DESIRED EMPLOYMENT

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Position

Date You Can Start

Salary Desired

Are You Employed Now?

Yes

If so may we Inquire of Your Present Employer?

Yes

Ever Applied to This Company Before?

Yes

Where?

When?

Ever Worked for this Company Before?

Yes

Where?

When?

Reason For Living

Name Of Last Supervisor at this Company

How Did You Find Out About This Position?

EDUCATION

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School Level

High School

Name and Location of School

No. of Years Attended

Did you Graduate?

Subjects Studied

School Level

College

Name and Location of School

No. of Years Attended

Did you Graduate?

Subjects Studied

School Level

Trade, Business or Correspondence School

Name and Location of School

No. of Years Attended

Did you Graduate?

Subjects Studied

GENERAL

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Subjects of Special Study or Research Work

Special Training, Certifications

Special Skills, Foreign Languages, Etc.

FORMER EMPLOYERS

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List Below Last Three Employers, Starting with the Most Recent.

Name of Present or Last Employer

Address

City

State

ZIP

Starting Date

Leaving Date

Job Title

Weekly Starting Salary

Weekly Final Salary

May We Contact Your Supervisor?

Yes

Name of Supervisor

Title

Phone

Description of Work

Reason For Leaving

Name of Previous Employer

Address

City

State

ZIP

Starting Date

Leaving Date

Job Title

Weekly Starting Salary

Weekly Final Salary

May We Contact Your Supervisor?

Name of Supervisor

Title

Phone

Description of Work

Reason for Leaving

Name of Previous Employer

Address

City

State

ZIP

Starting Date

Leaving Date

Job Title

Weekly Starting Salary

Weekly Final Salary

May We Contact Your Supervisor?

Yes

Name of Supervisor

Title

Phone

Description of Work

Reason for Leaving

REFERENCES

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List Professional References Whom We May Contact.

Name

Address

Business

Phone Number

Name 2

Address 2

Business 2

Phone Number 2

Name 3

Address 3

Business 3

Phone Number 3

Name 4

Address 4

Business 4

Phone Number 4

SERVICE RECORD

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Have You Ever Served in the U.S. Armed Forces?

Yes

Branch of Service

Discharge Date

Rank

Have You Ever Been Convinced of, Plead Guilty/No Contest to, or had a Suspended Imposition of Sentence for any Offense (Other than a Minor Traffic Violation)?

Yes

If Yes, Explain.

Free Text

( A Convictional Record will not necessarily exclude you from consideration. This information will be used only for job-related purposes and only to the extent permitted by law. )

AUTHORIZATION

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"I CERTIFY THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.

"I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES AND EMPLOYERS LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE AND RELEASE THE COMPANY FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM UTILIZATION OF SUCH INFORMATION.

" I ALSO UNDERSTAND AND AGREE THAT NO REPRESENTATIVE OF THE COMPANY HAS AN AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING, UNLESS IT IS IN WRITING AND SIGNED BY AN AUTHORIZED COMPANY REPRESENTATIVE.

"THIS WAIVER DOES NOT PERMIT THE RELEASE OR USE OF DISABILITY-RELATED OR MEDICAL INFORMATION IN A MANNER PROHIBITED BY THE AMERICANS WITH DISABILITIES ACT (ADA) AND OTHER RELEVANT FEDERAL AND STATE LAWS."

Date

Signature

Weston Paving Company Inc.

Phone: 865-984-1690 | Fax: 866-543-0649

Business Hours:

Mon - Fri: 8:00 am - 4:00 pm
Sat - Sun: Closed