Application for Work

[all fields are required]

Name: Full Name: First, Middle Initial, Last

Email: Email

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Application received-Thank you!

I am 18 years of age or older

I am a U.S. Citizen

I am a Military Veteran

Position (s) Applying For: Truck Operator, Mechanic, Flagger, Highway Class A CDL, Office, etc.

Available Start Date: Month/Day/Year

Name, location and highest grade completed of High School: High School Name, location and highest grade completed (9, 10, 11, 12, GED)

College, subjects studied, and degrees: College Information, subjects studied, and degrees. If NONE please note.

Additional Training- workshops, short courses, volunteer work, etc that relate to the job you are applying for: List additional training, If NONE please note.

I have a class A commercial drivers license

I have a class B commercial drivers license

Yes I have a current drivers license

Drivers License Number and State: DL# & State

I am certified in First/Aid CPR

I have attended training for MSHA at a previous job

You may contact my present employer

Present Employer Company Name: Present Employer Name

Present Job Title: Present Job Title

Company Address: Present Employer Full Address (Street/City/State/Zip Code)

Company Phone: Present Employer Phone

Start Date: Present Start Month/Year

Describe job duties, tools, or machines used: Present Employer duties, tools, or machines, or any other pertinent details

Reason for leaving: Present employer reason for leaving

You may contact this past employer (1)

Past Employer (1) Company Name: Past Employer (1) Name

Job Title: Past (1) Job Title

Company Address: Past Employer (1) Full Address (Street/City/State/Zip Code)

Company Phone: Past Employer (1) Phone

Start Date: Past (1) Start Month/Year

End Date: Past (1) End Month/Year

Describe job duties, tools, or machines used: Past Employer (1) duties, tools, or machine or any other pertinent details

Reason for leaving: Past Employer (1) reason for leaving

You may contact this past employer (2)

Past Employer (2) Company Name: Past Employer (2) Name

Job Title: Past (2) Job Title

Company Address: Past Employer (2) Full Address (Street/City/State/Zip Code)

Company Phone: Past Employer (2) Phone

Start Date: Past (2) Start Month/Year

End Date: Past (2) End Month/Year

Describe job duties, tools, or machines used: Past Employer (2) duties, tools, or machine or any other pertinent details

Reason for leaving: Past Employer (2) reason for leaving

You may contact this past employer (3)

Past Employer (3) Company Name: Past Employer (3) Name

Job Title: Past (3) Job Title

Company Address: Past Employer (3) Full Address (Street/City/State/Zip Code)

Company Phone: Past Employer (3) Phone

Start Date: Past (3) Start Month/Year

End Date: Past (3) End Month/Year

Describe job duties, tools, or machines used: Past Employer (3) duties, tools, or machine or any other pertinent details

Reason for leaving: Past (3) Employer reason for leaving

YES, If I should become an employee of Kevin Kent Const. LLC, I wish to be considered for other positions within the company.

How did you hear about us:: How did you hear about us?

Any additional comments you wish to make: Additional information you wish to add to your application

Cell Phone: Enter Cell Number

Home Phone: Enter Home Number

Home Address: Enter Home Address Street, City, State, and Zip

Have you ever been convicted of a Felony?: Yes or No Past Felony?

If yes, list all felony convictions, giving a brief description, including dates and charge. A positive response will not necessarily affect you being considered for hire, IF NO PLEASE ENTER N/A: Enter Your Message

I hereby agree to submit to a urine drug test.

EDUCATION

EMPLOYMENT HISTORY

(list employers, starting with the most recent. Explain all gaps in time of employment. Fill section out carefully and completely)

Present Employer:

Past Employer - 1:

Past Employer - 2:

Past Employer - 3:

ADDITIONAL INFORMATION

By clicking SUBMIT below you agree to the following statement:

"I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that, if employed, falsified statements to this application shall be grounds for dismissal, and I agree to hold my employer harmless in the event of my dismissal based thereon.

I authorize investigation of all statements contained herein and to do background checks to give you any and all information concerning my previous employment and any pertinent information that may have, confidential or otherwise, and release all parties from all liability for any damage that may result from furnishing the same to you."

DRUG TESTING

I understand that it is a company policy of Kevin Kent Const. LLC that all prospective employees submit to a controlled substance test involving the collection of a urine sample that will be tested for the following controlled substances:

Marijuana, cocaine, opiates, amphetamines, and phencyclidine (PCP).

I understand that if I test positive for the use of controlled substances that I will be given a reasonable opportunity to confer with the company’s medical review officer before any positive result is reported to the company.

The results of the drug tests will be maintained by the medical review officer of the company who will report to Kevin Kent Const. LLC whether the test result was negative or positive. The results of any tests will not be released to any additional parties without my written authorization.

[applications are kept on file for 6 months]

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