Employment Application

Employer 1
Employer 1 Name

Dates Employed: Start Date

Dates Employed: End Date

Employer 1 Telephone

Employer 1 Job Title

Employer 1 Starting Hourly Rate/Salary

Employer 1 Ending Hourly Rate/Salary

Employer 1 Supervisor

Employer 1 Work Performed

Employer 1 Reason for leaving

Employer 2
Employer 2 Name

Dates Employed: Start Date

Dates Employed: End Date

Employer 2 Telephone

Employer 2 Job Title

Employer 2 Starting Hourly Rate/Salary

Employer 2 Ending Hourly Rate/Salary

Employer 2 Supervisor

Employer 2 Work Performed

Employer 2 Reason for leaving

Summarize special skills and qualifications acquired from employment or other experiences

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Give names, and telephone numbers of three references who are not related to you and are not previous employers.

Have you ever been injured on the job before?
YesNo

If yes, how?

Have you ever received disability income payments or workman's compensation payments?
YesNo

Have you ever had injuries that may cause you not to be able to perform any duties that may be required with this job?

Do you have a valid driver's license?
YesNo

Do you have a commercial driver's license (CDL)?
Class AClass BClass C

Have you had any speeding/traffic tickets, traffic accidents, or DUIs in the last 7 years?
YesNo
If yes, explain?

Name of person and phone number to call in case of an emergency

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

Add resume

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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. I understand that this application is not and is not intended to be a contract of employment.

In the event of employment, I understand that false or misleading information given in my application or interviews is cause for immediate dismissal without compensation. I understand, also, that I am required to abide by all rules and regulations of Thorne's Excavating Company, LLC. I also authorize and agree to submit to drug or alcohol testing on employer's request. Refusal will result in immediate dismissal without compensation.

Applicants agree to and will provide the following:
- Pass a pre-employment drug screen
- Provide two forms of Identification, one photo ID required
- Complete E-Verification process
- Provide bank account information for weekly direct deposits

Type in your full name as signature of applicant (required)

Today's Date

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