Careers

Pre-Employment Questionnaire Equal Opportunity Employer

Personal Information

Name *

First

Middle

Last

Present Address *

Address Line 1

City

State

Zip Code

Email

Phone *

Other contact no.

Date of Birth *

Are you legally eligible for employment in the United States? *

Yes
No

Have you ever worked with us before? *

Yes
No

When and How Long? *

Reason for leaving? *

Are you currently employed? *

Yes
No

Reason for leaving? *

List any skills or any machines and / or equipment you can operate and number of years experience: *

Have you ever been convicted of a crime in the past 10 years (Excluding traffic violations) *

Yes
No

If yes, please explain *

Are you able to perform moderate to heavy lifting and carrying? *

Yes
No

Have you ever had safety training? *

Yes
No

If yes, how much? *

Do you have at least six months experience in the installation, repair and inspection of underground utility work? *

Yes
No

If yes, does your experience include sanitary or storm sewer systems? *

Yes
No

If yes, please give a complete description of all underground utility work? *

Have you ever worked from blueprints or detailed work drawings or diagrams? *

Yes
No

If yes, in what type of work were you engaged and for what purpose did you see blueprints? Explain fully *

Desired Position *

Desired Salary *

Former Employers

List below Last Two Employers, Starting with Last One First

(1) Dates Employed

From MM-YY to MM-YY

(1) Name and Address of Employer

(1) Phone

(1) Position

(1) Reason for Leaving

(2) Dates Employed

From MM-YY to MM-YY

(2) Name and Address of Employer

(2) Phone

(2) Position

(2) Reason for Leaving

Do you have an active Drivers License? *

Yes
No

DL # *

include State

Have you ever had a DWI or DUI? *

Yes
No

List any Certificates, Degrees or License that you have: Include year obtained and where

Authorization

"I certify that the facts contained in the application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment."In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

Signature *

Clear Signature

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Personal Information

Former Employers

Authorization