Name

Date

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Position Applying For

Rate of Pay Expected

Type of Employment You Are Looking For:

Are You Currently Employed?

If No, When Last Employed?

Company Name

From

To

Street Address

City

State

Zip Code

Contact Name

Phone

Fax

Duties Performed

Salary or Hourly Rate

Reason For Leaving

Company Name

From

To

Street Address

City

State

Zip Code

Contact Name

Phone

Fax

Duties Performed

Salary or Hourly Rate

Reason For Leaving

Company Name

From

To

Street Address

City

State

Zip Code

Contact Name

Phone

Fax

Duties Performed

Salary or Hourly Rate

Reason For Leaving

Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Have you ever had any license, permit or driving privilege suspended or revoked?

Have you been convicted of a traffic violation in the last 3 years?

Do you have a CDL?

Please List Any Heavy Equipment Experience:

Years of Exp

Do you have any special training, skills, qualifications or other experience that relate to the position(s) applied for?

High School Name/Location

Years Completed

College Name/Location

Years Completed

Graduate/Vocational School

Years Completed

Additional Educational Training?

Name

Relationship

Years Acquainted

Address

Phone

Name

Relationship

Years Acquainted

Address

Phone

Name

Relationship

Years Acquainted

Address

Phone

I certify that all statements I have made in this application are trues and agree that any misrepresentations or omission of facts may result in cancellation of my application for employment or immediate dismissal. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I further authorize any and all necessary reference checks and give permission for Anytime Excavating to obtain current or future abstract of my driver's license.

I understand that Anytime Excavating has a Drug, Alcohol and Substance Use/Abuse policy and that any offered employment is conditional upon successful passing of a drug, controlled substance and alcohol screening test.

This application for employment shall be considered active for a period of time not to exceed forty-five (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.

The applicant understands that neither this document nor any offer of employment from the employer constitutes an employment contract unless a specific document to that affect is executed by the employer and employee in writing.

In the event of employment, I understand that false or misleading information given in application or interview(s) may result in discharge. I understand also that I am required by all rules and regulation of the employer. I understand that my employment and compensation can be terminated, with or without cause, and with or without notice at any time, at the option of either the company or myself.

Name

Date