Employment Application

Employment Application Form

Date of Application

First Name

Middle Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone Number

Alternative Contact Number

Date Available to Start Work

Other Position Applied For

Type of License

Operator

Commercial (CDL)

State of Issue

Drivers License Number

Expiration Date

Have you ever served in the military?

Yes

Military Service

Branch of the Military

Served From

Served Until

Rank at Discharge

Type of Discharge

If other than honorable, please explain

Educational History

School 1 - Type

School 1 - Name and Location

School 1 - Highest Grade Completed

School 2 - Type

School 2 - Name and Location

School 2 - Highest Grade Completed

School 3 - Type

School 3 - Name and Location

School 3 - Highest Grade Completed

Previous Employment

Current Employer

Current Location

Current Position

May we contact them?

Yes

Current Supervisor's Name/Title

Current Primary Responsibilities

Current Employer's Phone

Current Employment From

Current Employment Until

Current Starting Salary

Current Ending Salary

Reason for Leaving Current Job

Prior Employer

Prior Location

Prior Position

May we contact them?

Yes

Prior Supervisor's Name/Title

Prior Primary Responsibilities

Prior Employer's Phone

Prior Employment From

Prior Employment Until

Prior Starting Salary

Prior Ending Salary

Reason for Leaving Prior Job

Prior 2 Employer

Prior 2 Location

Prior 2 Position

May we contact them?

Yes

Prior 2 Supervisor's Name/Title

Prior 2 Primary Responsibilities

Prior 2 Employer's Phone

Prior 2 Employment From

Prior 2 Employment Until

Prior 2 Starting Salary

Prior 2 Ending Salary

Reason for Leaving Prior 2 Job

Additional Experience

Background Information

The Company will consider qualified applicants, including those with criminal histories, in a manner consistent with federal, state, and local law. Disclosing criminal convictions will not automatically disqualify you from employment and you should answer the following questions truthfully and completely.

During the past ten years, have you been convicted of a felony?

Yes

If yes, please explain the nature of the charge(s), sentencing, date of conviction, and jurisdiction where the conviction occurred (e.g., county and state)

At any time, have you been convicted of a violent crime (e.g., actual or attempted assault, battery, rape, murder, etc.)?

Yes

If yes, please explain the nature of the charge(s), sentencing, date of conviction, and jurisdiction where the conviction occurred (e.g., county and state)

Acknowledgments

Please read each paragraph carefully. By checking the box next to each, you acknowledge that you have read and understood the paragraph.

Drug Testing

I understand and agree

Medical Exam

I understand and agree

Training

I understand and agree

Termination

I understand and agree

Information Provided

I understand and agree

I have read and understand Jordan Pile Driving, Inc.’s Equal Employment Opportunity Policy;

I agree to comply with the policies prohibiting discrimination, harassment, or retaliation, including the mandatory Complaint Reporting Procedure throughout the period of my employment; and

I understand that my failure to comply with the above policies will result in discipline, up to and including immediate termination.

Verification

Military Service

Educational History

Previous Employment

Background Information

Acknowledgments

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