Job Application | T Buck Construction Inc.

PERSONAL INFORMATION

First Name *

M.I. *

Last Name *

Mailing Address *

Town/City *

State *

Zip Code *

Physical Address (if different than mailing address)

Town/City

State

Zip Code

Home Phone *

Mobile Phone

Email Address *

Emergency Contact

Emergency Contact Phone

EMPLOYMENT DESIRED

Position you are applying for *

Date you can start *

Month

Day

Year

Salary desired *

Are you currently employed? *

If so, may we inquire of your present employer?

Have you ever worked for this company before? *

If yes, when?

EDUCATION & TRAINING (Complete all that apply)

High School

Name & Location

Dates Attended/Graduated

Course of Study

Technical School

Name & Location

Dates Attended/Graduated

Course of Study

College

Name & Location

Dates Attended/Graduated

Course of Study

U.S. Military

Branch & Location

Dates Served

Course of Study

Have you had OSHA 10 hour training? *

Do you have a valid driver's license? *

If so, what class(es)?

Do you own your own transportation? *

Are you willing to travel? *

Do you have experience operating construction equipment? *

If so, please list equipment and years experience

If you have welding experience, what processes and certifications do you hold?

Please tell us about any other special qualifications which may be of interest to us

EMPLOYMENT HISTORY

Current or Most Recent Employer

Name of Business/Organization

Address

Town/City

State

Zip Code

Name of Supervisor

Phone #

Position & Duties

From

Starting Rate of Pay

Ending Rate of Pay

Reason for Leaving

Previous Employer

Name of Business/Organization

Address

Town/City

State

Zip Code

Name of Supervisor

Phone #

Position & Duties

From

Starting Rate of Pay

Ending Rate of Pay

Reason for Leaving

Previous Employer

Name of Business/Organization

Address

Town/City

State

Zip Code

Name of Supervisor

Phone #

Position & Duties

From

Starting Rate of Pay

Ending Rate of Pay

Reason for Leaving

REFERENCES

List below names of three persons not related to you, whom you have known at least one year.

Reference #1

Name *

Address *

Home/Work Phone

Mobile Phone

Reference #2

Name *

Address *

Home/Work Phone

Mobile Phone

Reference #3

Name *

Address *

Home/Work Phone

Mobile Phone

Voluntary Equal Opportunity Questionnaire (optional)

As an equal opportunity employer, we hire without consideration to race, religion, creed, color, national origin, age, gender, sexual orientation, veteran status or disability. We invite you to complete the optional self-identification fields below used for compliance with government regulations and record-keeping guidelines.

Gender

Race

Veteran/Disability

Please read and check each paragraph below (if there is any part of this page you do not understand, please ask about it prior to submitting).

I expressly authorize, without reservation, the Company, its representatives, employees or agents to contact and obtain information from all references, employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I certify that all the facts set forth in the above employment application are true and complete to the best of my knowledge and I authorize the company to verify their accuracy and to obtain reference information on my work performance. I hereby release the company from any and all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information. I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for employment termination without prior notice.

Authorization1 *

I understand that in evaluating my application for employment and to evaluate my continued suitability for employment, the Company may from time to time procure or have prepared an employment, education, criminal history, motor vehicle, military and/or investigative report, or a report about my background, character, general reputation, mode of living, and/or employment performance about me. I consent to and authorize the Company to obtain these reports, and by copy of this authorization, I have been notified that: 1. the reports may be requested; 2. that upon request, I will be informed whether such a report has been requested; and 3. that upon request, I will be informed of the name and address of any agency that furnished any report.

Authorization 2 *

I also understand that upon written request and within five days after receipt of my request, I am entitled to complete disclosure about the nature and scope of this investigation. I authorize all persons, schools, employers, companies, corporations, law enforcement agencies and other government agencies to release information to the Company and to any company hired by them. The authorization includes matters of opinion relating to character, ability, reputation and past performance.

Authorization 3 *

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the Company reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the President of the Company. I also understand that if I hired, I will be required to provide proof of identity and legal authorization to work in the US and that federal immigration laws require me to complete an I-9 in this regard.

Authorization 4 *

I understand that any offer of employment is subject to, and conditioned upon, drug and alcohol tests when required by federal law. I agree to sign a separate consent form for such testing and a Release of Information Form required by the Department of Transportation to allow the Company to obtain my pervious two years’ drug and alcohol testing from my prior employers.

Authorization 5 *

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

Authorization 6 *

Submission of this application certifies that you have read and understand this complete page, and agree to the terms and conditions outlined in this document.

Type Your Full Name *

Date of Submission *