CAREERS AT TOTAL PAVING

STREAMLINED PERFORMANCE • UPSTANDING QUALITY

An Equal Opportunity Employer

We do not discriminate on the basis of race, color, religion, national origin, sex, age, or disability. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.

Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non job-related information.

APPLICATION FOR EMPLOYMENT

    Job Applied for*
    Date*
    Are you seeking:*
    When could you start work?
    Last Name*
    First Name*
    Middle Name*
    Email Address*
    Telephone Number*

    Present Street Address Part-time Temporary First Name

    City*
    State*
    Zip Code

    Are you 18 years of age or older?*

    (If you are hired, you may be required to submit proof of age.)

    Social Security # (Optional)
    If hired, can you furnish proof you are eligible to work in the U.S.?*

    Have you ever applied here before?*

    Were you ever employed here?*

    Have you ever been convicted of any law violation (except a minor traffic violation)?*

    Are you now or do you expect to be engaged in any other business or employment?*

    How many days of work have you missed during the past year? (Exclude absences due to disability or those covered by FMLA.)

    For Driving Jobs Only:

    Do you have a valid driver's license?*

    Have you had your drivers license suspended or revoked in the last 3 years?*

    List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability or other protected status.)

    LIST NAME AND ADDRESS OF SCHOOLS

    High School or GED:

    Number of Years Completed
    Diploma/ Degree/ Certificate
    Subjects Studied
    College or University:

    Number of Years Completed
    Diploma/ Degree/ Certificate
    Subjects Studied
    Vocational or Technical:

    Number of Years Completed
    Diploma/ Degree/ Certificate
    Subjects Studied

    What skills or additional training do you have that relate to the job for which you are applying?

    What machines or equipment can you operate that relate to the job for which you are applying?

    List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. Note: A job offer may be contingent upon acceptable references from current and former employers.

    NAME OF EMPLOYER
    ADDRESS
    CITY
    STATE
    ZIP CODE
    SUPERVISOR
    TELEPHONE

    JOB TITLE AND DUTIES
    DATES OF EMPLOYMENT (Mo/Yr):

    FROM
    TO

    PAY:

    START $
    FINAL $

    REASON FOR LEAVING

    NAME OF EMPLOYER
    ADDRESS
    CITY
    STATE
    ZIP CODE
    SUPERVISOR
    TELEPHONE

    JOB TITLE AND DUTIES
    DATES OF EMPLOYMENT (Mo/Yr):

    FROM
    TO

    PAY:

    START $
    FINAL $

    REASON FOR LEAVING

    NAME OF EMPLOYER
    ADDRESS
    CITY
    STATE
    ZIP CODE
    SUPERVISOR
    TELEPHONE

    JOB TITLE AND DUTIES
    DATES OF EMPLOYMENT (Mo/Yr):

    FROM
    TO

    PAY:

    START $
    FINAL $

    REASON FOR LEAVING

    Have you worked or attended school under any other name?*

    Are you presently employed?*

    Have you ever been fired from a job or asked to resign?*