WE'RE HIRING NEAR YOU! | A-1 DRILLING & BLASTING

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Employment Application

This Company is an equal opportunity employer dedicated to nondiscrimination in employment.The Company selects the best qualified individual for the job based on job-related qualifications regardless of race, age, color, 􀁯religion, sex, national origin, ancestry, marital status, sexual preference, disability, or any other basis protected by applicable law.

ALL information requested.

First name

Middle name

Last name

Present Address

Permanant Address (if different)

Home Phone

Message Phone

Social Security #

If you are hired, can you furnish proof that you are over 18 years of age?

Yes

No

If you are hired, can you present evidence of your legal right to live and work in this country as required by law?

Yes

No

Are you able to satisfactorily perform the essential job duties required of the position for which you are applying?

Yes

No

Do you require a reasonable accommodation to perform the essential job duties of the position for which you are applying?

Yes

No

If you answered yes, what reasonable accommodation do you require?

Position Desired

Date you can start

Salary Desired

Which do you prefer?

Full Time

Part Time

Part Time Hours Available

Are you currently employed?

Yes

No

If yes specify dates

High School Name:

City & State

# of Yrs Completed

Did you graduate?

Degree(s)

College:

College City & State

# of Yrs of College

College graduate?

College Degree(s)

Graduate:

Graduate City & State

# of Yrs of Graduate School

Did you graduate?

Degree(s)

Have you served in the United States Armed Forces?

Branch

Final Rank

Honorable Discharge?

Additional training, skill, experience, and special achievements that you would like us to consider.

List present and past employers beginning with the most recent. Attach additional information as needed.

1- Dates of Employment

1- Name of Employer

1- Address of Employer

1- Position

1- Supervisor

1- Starting Pay

1- Ending Pay

1- Reason for Leaving

2- Dates of Employment

2- Name of Employer

2- Address of Employer

2- Position

2- Supervisor

2- Starting Pay

2- Ending Pay

2- Reason for Leaving

3- Dates of Employment

3- Name of Employer

3- Address of Employer

3- Position

3- Supervisor

3- Starting Pay

3- Ending Pay

3- Reason for Leaving

Have you ever been terminated or asked to resign from any job?

If yes, please explain circumstances

Please explain fully any gaps in your employment history

How many days of work have you missed in the last three years due to reasons other than paid holidays, vacation, and approved absence due to the Family Medical Leave Act?

Do you have adequate transportation to and from work?

Do you have any friends or relatives who work for the Company?

List three personal references who know you well but who are not previous employers or relatives.

1- Name

1- Address

1- Phone #

2- Name

2- Address

2- Phone #

3- Name

3- Address

3- Phone #

This application will be considered active for a maximum of thirty (30) days. If you wish to be considered for employment after that time, you must reapply.

I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE AND ACCURATE.

Thank you! We’ll be in touch.

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