Job Application

Full Name:
Address:
Home Phone:
Cell Phone:
Social Security Number	Are you at least 18? Yes No
Date of Birth:

Are you able to lift at least 50 lbs? Yes No

Have you ever been convicted of a crime?Yes No |If yes, please explain:

Are you a United States citizen? Yes No If you are not a United States citizen, can you provide an EAD (Employment Authorization Document)? Yes No

Do you have dependable means of getting to work? Yes No

What is your highest level of education? High School Diploma GED if neither Diploma nor GED what is the highest grade completed?

Hours may vary from week to week due to weather conditions. You may be asked to start early, work late or on weekends to stay on schedule when there are delays due to weather. Will this type of work schedule present a problem for you? Please comment:

When would you be available to start work?

If this is your first job? Yes No

Previous Employment History:

Company:
Address:
Phone:
City:
State:
Supervisor:
Job Description:
Starting wage:	$
Ending wage:	$
From:
To:
Reason for leaving:

Company:
Address:
Phone:
City:
State:
Supervisor:
Job Description:
Starting wage:	$
Ending wage:	$
From:
To:
Reason for leaving:

Company:
Address:
Phone:
City:
State:
Supervisor:
Job Description:
Starting wage:	$
Ending wage:	$
From:
To:
Reason for leaving:

List any other experience or training that you feel would be pertinent to your application for this position:

I certify that the information on this application is accurate and complete and understand that my former employers may be contacted for reference. Please write your name as form of Signature:

Last Updated: May 19, 2009