Employment

First Name*

MI

Last Name*

Street Address*

City*

State*

Zip*

Home Phone

Cell Phone*

Email Address*

Referral Source (How did you hear about us?)

Have you ever been employed here before? (If yes, list dates & supervisor)

Positions applying for

Date available for work*

Type of employment desired

Full-Time

Part-Time

Temporary

Seasonal

Are you over the age of 18?*

Yes

No

Are you willing to travel?*

Yes

No

Are you willing to work overtime/weekends if necessary?*

Yes

No

Can you perform duties of job you're applying for?*

Yes

No

Driving History

If applying for a position which may require you to drive a vehicle, please answer the following

Driver's License #

State

Expiration Date

CDL License #

Endorsements

Have you ever had any traffic violations or motor vehicle accidents within the past 3 years?

Yes

No

Education

Last year completed*

Year Completed*

College Degree

Year Completed

Special Training, skills, apprenticeship, vocational school (list machines, equipment operated or any other experience in general or heavy highway construction):

Military Service

Branch & Length of Service:

MOS:

Present Classification:

Type of Discharge:

Employment History

(Please explain any lapses in time (i.e. months, years) of employment).

Employer #1 (present or most recent):

Company:

Supervisor:

Address:

Telephone:

Employed From (Month and Year):

Wkly Pay (Start to Finish):

List Job Title and Describe Your Work:

Reason for Leaving:

Employer #2 (present or most recent):

Company:

Supervisor:

Address:

Telephone:

Employed From (Month and Year):

Wkly Pay (Start to Finish):

List Job Title and Describe Your Work:

Reason for Leaving:

Employer #3 (present or most recent):

Company:

Supervisor:

Address:

Telephone:

Employed From (Month and Year):

Wkly Pay (Start to Finish):

List Job Title and Describe Your Work:

Reason for Leaving:

Do Not Contact

Employer No.(s):

Reason:

Personal References:

List names and phone numbers of personal or additional work references who are not related to you and are not previous supervisors.

Reference #1

Name:

Relationship to You:

Phone

No. of Years Known

Reference #2

Name:

Relationship to You:

Phone

No. of Years Known

Read the statement carefully before submitting this application.

I understand that any omission or misrepresentation of facts in this application may result in refusal of or separation from my employment. By signing this application, I agree to a MVR (Motor Vehicle Report) check on my driving record. Before employment with Bluegrass Contracting Corporation, I will submit to a drug screen test by a doctor and lab selected by the Company. I grant permission to perform reference checks with employers listed on this application, except as noted above. If employed, I agree to abide by all the rules and regulations of the Company.

HP Name

If you would like to apply please complete our application below. Thank you!

Driving History

Education

Military Service

Employment History

Employer #1 (present or most recent):

Employer #2 (present or most recent):

Employer #3 (present or most recent):

Do Not Contact

Personal References:

Reference #1

Reference #2