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Online Application

 

Online Application

Application For Employment

We Are An Equal Opportunity Employer
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

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Please Specify Other:  

Last Name:  

First Name:  

Middle Name:  

Street Address:  

City:           State:           Zip:  

Telephone:  Day Evening         Social Security Number:

If you are under 18 years of age, can you provide required proof of your eligibility to work?
  Yes    No   

Have you ever filed an application with us before?

  Yes    No              If Yes, give date:   (please use: mm/dd/yy)

Have you ever been employed with us before?

  Yes    No              If Yes, give date:   (please use: mm/dd/yy)

Are you currently employed?   Yes  No        May we contact your present employer?  Yes  No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
  Yes    No      (Proof of citizenship or immigration status will be required upon employment.)

On what date would you be available for work?   (please use: mm/dd/yy)

Are you available to work:  Full Time       Part Time       Shift Work       Temporary

Are you currently on "lay-off" status and subject to recall?    Yes    No

Can you travel if a job requires it?    Yes    No

Have you been convicted of a felony within the last 7 years?    Yes    No
(Conviction will NOT necessarily disqualify an applicant from employment.)

If yes, please explain.  

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

Describe any job-related training received in the United States military.  

 

Employment Experience

Start with your present or last job.  Include any job-related military service assignments and volunteer activities.  You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer:   
Address:    
Telephone:    Dates Employed:    From   To   (please use: mm/dd/yy)
Job Title:       Supervisor:   

Hourly Rate/Salary - Starting:     Hourly Rate/Salary - Final:  
Work Performed:

Reason for Leaving:

Employer:   
Address:    
Telephone:    Dates Employed:    From   To   (please use: mm/dd/yy)
Job Title:       Supervisor:   

Hourly Rate/Salary - Starting:     Hourly Rate/Salary - Final:  
Work Performed:

Reason for Leaving:

Employer:   
Address:    
Telephone:    Dates Employed:    From   To   (please use: mm/dd/yy)
Job Title:       Supervisor:   

Hourly Rate/Salary - Starting:     Hourly Rate/Salary - Final:  
Work Performed:

Reason for Leaving:

Employer:   
Address:    
Telephone:    Dates Employed:    From   To   (please use: mm/dd/yy)
Job Title:       Supervisor:   

Hourly Rate/Salary - Starting:     Hourly Rate/Salary - Final:  
Work Performed:

Reason for Leaving:

Employer:   
Address:    
Telephone:    Dates Employed:    From   To   (please use: mm/dd/yy)
Job Title:       Supervisor:   

Hourly Rate/Salary - Starting:     Hourly Rate/Salary - Final:  
Work Performed:

Reason for Leaving:

Additional Information

State any additional information you feel may be helpful to us in considering your application.

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied?  A description of the activities involved in such a job or occupation can be obtained from Employment@jacksonpaving.com.     Yes  No 

References

Full Name: 
Address:    
                 
                   Day Telephone:              Evening/Night Telephone:

Full Name: 
Address:    
                 
                   Day Telephone:              Evening/Night Telephone:

Full Name: 
Address:    
                 
                   Day Telephone:              Evening/Night Telephone:

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days.  Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause.  It is further understood that this
 "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.  I understand, also, that I am required to abide by all rules and regulations of the employer.

By submitting this completed application I am agreeing to the above statement.

Please give us your E-mail address:  

      

 

 

  
 
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