LAKESIDE CONCRETE CUTTING, INC. EMPLOYMENT APPLICATION

Transcription

1 LAKESIDE CONCRETE CUTTING, INC. EMPLOYMENT APPLICATION Return to: 51 Marginal Way PLEASE READ CAREFULLY Lakeside Concrete Cutting, Inc. affords equal employment opportunity to all qualified persons without regard to race, color, religion, sex, age, national origin or veteran status. Women, veterans and minorities are encouraged to apply. Notwithstanding the submission of a resume or other material, no applicant will be considered for employment unless he or she has completed this application in full. Providing any incomplete, false or misleading info in this application, any resume or other supporting document or during the screening/interview process shall be sufficient grounds to refuse to employ or, having been employed, to immediately discharge. Lakeside Concrete Cutting, Inc. is an open-shop employer and people are hired for a specific project; accordingly, employment should be regarded as temporary. When an assignment ends, and as needs dictate, employees may be offered another assignment on a different project. Employment is at the will of both parties and continued employment depends on many factors such as Lakeside Concrete Cutting, Inc s ability to provide additional work and the employee's skills, work performance, and ability to travel to other projects. I understand that this application for employment is not a contract for employment. I further state that the information given is strictly voluntary and is true to the best of my knowledge. I authorize Lakeside Concrete Cutting, Inc to verify any aspect of the information given here and understand that misrepresentations or omissions of facts may be grounds for cancellation of the application or termination of employment if I become employed by Lakeside Concrete Cutting, Inc. I further authorize Lakeside Concrete Cutting, Inc to make investigations to my previous employers in accordance with Federal Motor Carrier safety regulations , the information supplied in this application may be used, and previous employers contacted, to investigate my safety performance history and I have the right to review information provided by my previous employers, the right to have errors corrected by my previous employers and resent to Lakeside Concrete Cutting, Inc, and the right to have a rebuttal statement attached to any information that my previous employers and I cannot agree on; (Investigations and inquiries); (Notification of previous employment); and (Release of alcohol and controlled substance test information by previous employers). I authorize all previous employers to release information regarding my employment to Lakeside Concrete Cutting, Inc, including my reason for leaving. I authorize Lakeside Concrete Cutting, Inc. to release information to potential future employers in accordance with the same. Should I be offered and accept employment, I agree to conform to all policies, rules, and regulations of the company governing the conduct of its employees and agree to work in a safe manner at all times while employed by Lakeside Concrete Cutting, Inc. I hereby release my prior employers and Lakeside Concrete Cutting, Inc. from any liability for damage resulting from the information provided. I, the undersigned, have read the above and foregoing notice and understand the same. PRINT NAME SIGN NAME DATE 1

2 Application Date First Name Middle Name Last Name Social Security # Address Primary Phone Secondary Phone Emergency Contact Person Emergency Contact Person s Phone Number Are you capable of lifting up to 50 lbs? (circle one) YES NO Are you at least 18 years old? (circle one) YES NO Are you eligible to be lawfully employed in the United States? (circle one) YES NO Do you have a valid drivers license? (circle those that apply) CLASS A, CLASS B, CDL, CLASS C Within the last 5 years, have you had any license to operate any motor vehicle suspended or revoked by any authority for any reason? (circle one) YES NO If yes, please attach a separate page explaining and include the dates and the reason(s) for the suspension(s) or revocation(s). Do you have a means of transportation to our work site(s)? (circle one) YES NO How far are you willing to travel? (circle one) Not willing to travel Up to 50 miles Up to 100 miles Willing to travel to any assignment Are you willing to stay overnight at a motel room when assigned to certain far-away projects (for example, Portland, Calais or Presque Isle)? (circle one) YES NO Are you willing to: begin work at 5AM, work 12 hour days, work nights, work Saturdays, or work Sundays if and when required, sometimes with short or little notice? (circle one) YES NO Travel to construction projects as well as routine overtime and Saturday work are common. You must be willing to travel when and where assigned and be available to work hours as determined by Lakeside Concrete Cutting Inc. The company provides travel expenses and motel accommodations when employees are required to travel specified distances and stay away from home. 2

3 Do you have any experience using hand held saws? (circle one) YES NO If you answered yes above, what kinds of hand held saws have you used? Please be honest with us. Sawing experience is not required for this position. Have you ever been a mechanic or do you have any mechanical experience? (circle one) YES NO Please explain your mechanical experience, at home or work: What is the earliest date you are available to start working? BACKGROUND Within the last five years, have you plead guilty or no contest to or been convicted of a crime? YES NO Within the last five years, have you been disciplined, either orally or in writing, by any previous employer or supervisor? YES NO Within the last five years, have you been discharged from a place of employment? YES NO Within the last five years, have you been asked to resign from a place of employment? YES NO Have you ever had any professional license suspended or revoked? YES NO IF YOU HAVE ANSWERED YES TO ANY OF THE FIVE BACKGROUND QUESTIONS ABOVE, PLEASE ATTACH A SEPARATE PAGE OR PAGES WITH A COMPLETE EXPLANATION FOR EACH QUESTION TO WHICH YOU ANSWERED YES. ANY EXPLANATION SHALL INCLUDE A DETAILED DESCRIPTION AND THE DATES OF THE CIRCUMSTANCES REQUIRING YOU TO ANSWER YES EQUIPMENT EXPERIENCE PLEASE CIRCLE BELOW ALL VEHICLES OR EQUIPMENT WITH WHICH YOU HAVE EXPERIENCE Skid Steer Forklift (rough terrain) Chain Saw Impulse Hammer Forklift (warehouse) Skill Saw Loader Grader Table Saw Dump Truck Roller Gas Demo Saw Backhoe Excavator SawZall Bulldozer Boom Truck Hammer Drill Crane Pulp Truck Concrete Saw Skidder Wood Splitter Core Drill 3

4 SUPERVISOR EXPERIENCE Have you ever acted as a supervisor to another person or supervised a crew? (circle one) YES NO If you answered yes above, what kinds of activities did you supervise? SAFETY CERTIFICATIONS Have you completed any of the following training courses: (circle any you have completed) OSHA 10 HOUR OSHA 30 HOUR OSHA 40 HOUR hazwopper confined space training competent person excavation training utility trench excavation training certified signal person training qualified rigger training fork truck operator training WELDING EXPERIENCE AND CERTIFICATIONS Do you have experience welding? (circle one) YES NO Do you have any of the following welding qualifications? (circle any which apply) F.C.A.W. G.M.A.W. G.T.A.W. S.M.A.W. field welding techniques purging cut with oxygen/acetylene torches use backing (fiberglass/ceramic) 4

5 WORK HISTORY & WORK REFERENCES (if no work experience, list a school and teacher) Most Recent Employer Company Name/Location Supervisor Name and Phone Number Your Job Title Short Description of Duties You Performed Start & End Dates Pay Rate Next Most Recent Employer Company Name/Location Supervisor Name and Phone Number Your Job Title Short Description of Duties You Performed Start & End Dates Pay Rate Next Most Recent Employer Company Name/Location Supervisor Name and Phone Number Your Job Title Short Description of Duties You Performed Start & End Dates Pay Rate 5

6 EDUCATION please provide information about all levels of education you have completed Return to: 51 Marginal Way High School Name & Location Number of Years Attended Degree Trade School/College Name & Location Number of Years Attended Degree Graduate/Other School Name & Location Number of Years Attended Degree ADDITIONAL INFORMATION ABOUT YOURSELF Please include any information that you think may be useful to your application We strongly recommend explaining all breaks in employment during the past 10 years, even if this means attaching additional pages explaining all breaks in employment. Please attach additional pages, resumes, copies of certifications & licenses 6