Position Desired
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Employee # |
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Date
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Street Address
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Telephone
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Email (optional)
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Have you ever applied
for employment or worked for us before?
Please check if yes, If yes: Date
Location
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Rate
of pay expected
$
per hour |
Apart from absence
for religious observation, are you available for full time work?
Check if Yes, If not, what hours can you work?
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Date
available for employment?
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Are you legally
eligible for employment in the United States?
Check if Yes
Proof of citizenship or immigration status will be required upon employment
(I.E.:Passport, Alien Registration Card, driver's license, Social
Security card and birth certificate.) |
Will
you work overtime if asked?
Check if Yes |
If you are less
than 18 years of age, can you provide required proof of your eligibility
to work?
Check if Yes
You will be required to provide a school work permit |
The position for
which you are applying may require overnight or out of town employment,
do you have any objections to this arrangement?
Check if Yes |
If requested, would you be willing to take a pre-employment drug/alcohol-screening
test as a condition of employment?
Check if Yes |
Does present employer know you plan employment change?
Check if Yes
Why do you desire to make a change?
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Have you ever been fired or forced to resign from
previous employment?
Check if Yes |
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EMPLOYMENT
HISTORY
Please give accurate, complete full time and part time employment
record. Start with your present or most recent employer.
Are you currently employed?
Check if Yes. |
Employer
Address
Name of Supervisor
Job title and describe work performed
What did you like about this job?
What did you dislike about
this job?
|
Telephone
Employed (month & year)
from
to
Hourly Rate/Salary
Start $
Final $
Reason for leaving
May we contact this employer?
Check if Yes |
| |
Employer
Address
Name of Supervisor
Job title and describe work performed
What did you
like about this job?
What did you dislike about this job?
|
Telephone
Employed (month & year)
from
to
Hourly Rate/Salary
Start $
Final $
Reason for leaving
May we contact this employer?
Check if Yes |
| |
Employer
Address
Name of Supervisor
Job title and describe work performed
What did you
like about this job?
What did you dislike about this job?
|
Telephone
Employed (month & year)
from
to
Hourly Rate/Salary
Start $
Final $
Reason for leaving
May we contact this employer?
Check if Yes |
| |
|
Employer
Address
Name of Supervisor
Job title and describe work performed
What did you
like about this job?
What did you dislike about this job?
|
Telephone
Employed (month & year)
from
to
Hourly Rate/Salary
Start $
Final $
Reason for leaving
May we contact this employer?
Check if Yes |
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| UNEMPLOYMENT
PERIODS |
| (During past 5 years) if there are any unemployment periods
of a month or more between schooling, military, or employed periods,
please list the dates, along with the names and addresses of persons
other than relatives who can confirm this information. |
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| EDUCATION |
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WORK
SKILLS & QUALIFICATIONS
Indicate Training & Experience
in the following: |
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Area
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Yrs.
Exp.
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Area
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Yrs.
Exp.
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Area
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Yrs.
Exp.
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| SAFETY
TRAINING |
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| MILITARY |
Branch
Period of Service: From
To
Duties or Special Training
Type of Discharge
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| CRIMINAL
BACKGROUND |
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| DRIVERS
LICENSE INFORMATION |
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| ADDITIONAL
INFORMATION |
| State any additional information you feel may be helpful to us in
considering your application.
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| REFERENCES |
Name
Address
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Phone
#
How long have you known them?
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Name
Address
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Phone
#
How long have you known them?
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| In
case of emergency notify: |
| Name:
Address:
Phone:
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APPLICANT’S
STATEMENT
These
answers are true and complete to the best of my knowledge. I authorize
you to make such investigation and inquiries of my personal, employment,
financial or medical history and other related matters as my be
necessary in arriving at an employment decision. I understand that
any false or misleading information provided during the application
or interview process will result in my immediate discharge if I
am hired, regardless of when discovered. I
UNDERSTAND THAT THIS APPLICATION IS NOT A CONTRACT OF EMPLOYMENT.
I ALSO UNDERSTAND THAT IF HIRED, REGARDLESS OF ANY ORAL REPRESENTATIONS
TO THE CONTRARY, THE EMPLOYMENT RELATIONSHIP BETWEEN MYSELF AND THE
COMPANY IS TERMINABLE-AT-WILL SO THAT BOTH THE COMPANY AND I REMAIN
FREE TO CHOOSE TO END OUR WORK RELATIONSHIP AT ANY TIME FOR ANY OR
NO REASON. ANY CHANGES IN THIS EMPLOYMENT RELATIONSHIP MUST BE MADE
IN WRITING AND WITHIN THE GUIDELINES OUTLINED IN THE COMPANY POLICY
HANDBOOK.
I
also understand that any offer of employment may be conditioned
upon a health evaluation by a doctor selected by the Company, to
determine whether I can perform the job duties. In addition, I
understand a drug or alcohol test may be required depending upon
Company policy. I authorize the Company to make a thorough investigation
of my past employment, education and job-related activities and
I release from all liability all persons, companies, and corporations
supplying such information. I also indemnify this Company and its’ employees
against liability which might result from making such investigation. |
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I have read and understand the applicant's statement above. |
| Signature of
Applicant:
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Date:
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For more information about current employment opportunities at Fisher Sand & Gravel
Co. or to request an application,
contact:
Todd Tavis
Human Resources Director
Fisher Industries
PO Box 1034
Dickinson, ND 58601
ttavis@fisherind.com
701-456-9184 - phone
701-456-9168 - fax |