Join Our Team

It is the policy of the Company not to discriminate in hiring and employment on the basis of race, color, religion, national origin, sex, disability, age or other protected class as provided by all applicable federal, state or local laws. No question on this application is intended to secure information for an unlawful purpose. Only fully completed applications will be considered for employment.

PERSONAL DATA

Name

First Middle Last

Address

Street Address Address Line 2 City State ZIP Code

Email Address

Telephone Number

Alternate Telephone Number

Are you 18 years of age or over? (Proof of eligibility to work will be required)

Yes

No

Are you a United States citizen or do you presently have the legal right to remain and work permanently in the United States? (Proof of right to work will be required)

Yes

No

If no, do you require sponsorship for employment?

Yes

No

If no, are you currently authorized to be employed by any employer in the United States?

Yes

No

EMPLOYMENT

Have you ever been involuntarily terminated from employment?

Yes

No

If yes, please explain:

Are you related to anyone currently employed by American Pavement Preservation?

Yes

No

If yes, please provide the name(s) and relationship(s):

Have you ever worked for American Pavement Preservation?

Yes

No

If yes, please provide dates of employment, position(s) held and reason(s) for leaving:

EMPLOYMENT RECORD

Include your current or most recent job first, list others in order. Account for all the time, including unemployment for the last 10 years.

Employment Record 1

Employer

Address

Street Address Address Line 2 City State ZIP Code

Telephone Number

Name of Supervisor

First Last

Title of Supervisor

Date Started

Date Ended

End Salary

Reason for Leaving

Position Held

Major Responsibilities

Add a Second Employment Record?

Yes

No

Employment Record 2

Employer

Address

Street Address Address Line 2 City State ZIP Code

Telephone Number

Name of Supervisor

First Last

Title of Supervisor

Date Started

Date Ended

End Salary

Reason for Leaving

Position Held

Major Responsibilities

Add a Third Employment Record?

Yes

No

Employment Record 3

Employer

Address

Street Address Address Line 2 City State ZIP Code

Telephone Number

Name of Supervisor

First Last

Title of Supervisor

Date Started

Date Ended

End Salary

Reason for Leaving

Position Held

Major Responsibilities

Add Other Employment Records?

Yes

No

All Other Employment Records

PROFESSIONAL REFERENCES

Please identify three professional / business references. At least one, but preferably all three, should be a person who managed or supervised you in prior employment.

Name

First Last

Company

Telephone Number

Nature of Relationship

Name

First Last

Company

Telephone Number

Nature of Relationship

Name

First Last

Company

Telephone Number

Nature of Relationship

APPLICANT RELEASE AND ACKNOWLEDGEMENT

By submitting this form I hereby certify that the information on this application of employment is true and correct. I agree that any misrepresentation, falsification, or omission in said information shall be cause for immediate dismissal from employment without protest. I understand that this application will be considered active for ninety (90) days. If I have not been employed within this time period, I will need to reapply for consideration.

In conclusion of my employment, I agree that my employment and compensation can be terminated, with or without cause or notice, at the Company’s or my option. No employee, other than the President of the Company, has any authority to enter into any agreement for employment for any specified period at a time. Any amendment to this statement must be in writing signed by the President. Likewise, neither the existence of the Company’s employee benefits, nor the programs and plans providing them, nor summaries of descriptions thereof are intended to, or do, alter the at will nature of employment.

By Submitting this form, I authorize the Company to investigate my background, and to obtain any and all information that may concern me, including but not limited to information as to my character, general reputation, personal characteristics, and mode of living. I further consent to being discussed by any person so contacted and hereby waive any and all rights to bring any action for defamation, invasion of privacy or any similar cause against anyone contacted as a result of what he/ she may say about me.

The Company is a Drug- Free Workplace. I understand that if I am offered employment, I will be required to submit to a drug test. I understand that any offer of employment is contingent upon satisfactorily completing the physical and drug test and hereby release the Company from any liability or damages in connection with, or reliance upon, such physical and drug test.

Date

Comments

This field is for validation purposes and should be left unchanged.

Employment Application

PERSONAL DATA

JOB INTEREST

EMPLOYMENT

EMPLOYMENT RECORD

Employment Record 1

Employment Record 2

Employment Record 3

PROFESSIONAL REFERENCES

APPLICANT RELEASE AND ACKNOWLEDGEMENT