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We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the application should notify a representative of the organization.

Applicant Information

Construction Crafts: Length of Craft : Date: (mm/dd/yyyy)

Name* Last: Legal First: Email:

Address: Apt:#: City: State: Zip:

Primary Telephone: Secondary Telephone:

*Two phone numbers are required

Social Security Number*: - - Date of Birth*:

Rate of Pay Desired: Date Available to Start Work:

(Foreman will determine the actual rate of pay)

Do you have a TWIC card?* No Yes If yes, date issued

List other types of cards, badges or certifications you have that may be useful in your position:

Are you able to meet the attendance requirements? Yes No
Do you have any objection to working overtime, if necessary? Yes No
Can you travel if required by this position? Yes No
Have you ever been previously employed by our organization? Yes No
Can you submit proof of legal emloyment authorization and identity? Yes No
(Two Forms of ID Required as per Federal I-9, We also participate in the E-Verify Program for document verification)

How were you referred to us?:

Employment History

Please provide employment information from your past three employers starting with most recent.

Employer Position

Dates Employed: From: To: Reason for Leaving:

Employer Position

Dates Employed: From: To: Reason for Leaving:

Employer Position

Dates Employed: From: To: Reason for Leaving:

Additional Notes or Comments