Employment

Position Applied For

Referral Source

Friend
Relative
Walk in
Other

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Social Security Number

If employed and you are under 18, can you furnish a work permit?

Have you applied here before

If Yes, give date

Have you been employed here before

If Yes, give date

Are you employed now

May we contact your current employer

If No, why not?

Are you prevented from lawfully being employed in this country due to Visa or immigration status. Proof of US citizenship or visa status may be required upon employment

On what date will you be available for work?

Are you available to work

Full time
Part time
Temporary

Are you on a lay-off subject to recall

Can you travel if the job requires it

Have you been convicted of crime in the last 7 years

If yes, please explain

Employment History

Employer 1

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Start Date

End Date

Job title

Work performed

Starting salary / hourly rate

Ending salary / hourly rate

Supervisor name

Reason for leaving

Employer 2

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Start date

End date

Job title

Work Performed

Starting salary / hourly rate

Ending salary / hourly rate

Supervisors Name

Reason for leaving

Employer 3

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Start date

End date

Job title

Work Performed

Starting salary / hourly rate

Ending salary / hourly rate

Supervisors name

Reason for leaving

Summarize special skills and qualifications acquired from employment or other experience

Applicant information

Please provide three references including name and phone number. Do not include relatives or family members.

Have you ever been injured on the job

If yes, please explain

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

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

Do you have a valid TN drivers license?

If no, why?

TN Drivers license number

Expiration date

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

If yes, please explain

Name of person and phone number to contact in case of emergency

Education

Elementary school name

Years completed

High school name

Years completed

Did you graduate?

Honors received?

College / University name

Years completed

Did you obtain a Degree?

Course of study

Honors received?

Graduate School / University name

Years completed

Did you obtain a degree

Course of study

Honors received?

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

Applicant's statement

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 submit to drug or alcohol testing on employer's request. Refusal will result in immediate dismissal without compensaton.

I certify

Type in you full name as your signature *

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Last

Employment

Employment History

Applicant information

Education

Applicant's statement

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