Date

MM

DD

YYYY

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Have you ever filed an application with us before? *

Yes

No

Under 18 years of age? *

Yes - I can provide proof of eligibility to work.

Yes - I cannot provide proof of eligibility to work.

No

Have you ever been employed by Sam Construction?

Yes

No

Are you currently employed? *

Yes

No

May we contact your present employer? *

Yes

No

Are you a US Citizen? *

Yes

No - I am not prevented from lawfully becoming employed in this country because of Visa or Immigration Status.

No - I am prevented from lawfully becoming employed in this country because of Visa or Immigration Status.

Available Start Date *

MM

DD

YYYY

How often are you available to work? *

Full Time

Part Time

Temporary

Are you currently on "lay-off" status or subject to recall? *

Yes

No

Are you able to travel if a project requires it? *

Yes

No

Did you graduate? *

Yes

No

Did you graduate? *

Yes

No

Phone

(###)

###

####

May we contact this employer?

Yes

No

Phone

(###)

###

####

May we contact this employer?

Yes

No

Phone

(###)

###

####

May we contact this employer?

Yes

No

Name

First Name

Last Name

Phone

(###)

###

####

Name

First Name

Last Name

Phone

(###)

###

####

Name

First Name

Last Name

Phone

(###)

###

####

Have you ever been convicted of a felony? *

Yes (Explain below)

No

Have you ever had your drivers license suspended? *

Yes (Explain below)

No

Have you ever been convicted of a misdemeanor? *

Including traffic tickets, DUI, speeding, reckless driving, etc.

Yes (explain below)

No

Military Service

Yes (List Type of Discharge below.)

No

Agree to submit to drug screening? *

I agree to submit a pre-employment drug test as a condition of employment?

Yes

No

*

I understand that there will be random drug testing at the employer's request as a condition of continued employment.

Yes

No

*

If I am injured on the job or if I am involved in a situation involving injury to another employee, I agree to be tested for drugs upon request by Sam Construction.

Yes

No

Do you use any form of tobacco? *

Yes (Explain below)

No

Physically Able to Perform Work? *

Carpenters, concrete workers, and construction laborers are required to be able to lift from the ground and over head 50 lbs or more. These jobs require bending, squatting, climbing ladders, working on one or both knees and use of both hands, arms, legs and feet for at least 8 hours per day. Can you perform the essential functions of the job, for which you are applying, either with or without reasonable accommodation?

Yes

No