KNOX CONCRETE CONSTRUCTION APPLICATION FOR EMPLOYMENT PERSONAL INFORMATION Date: Your Name: (required) Present Address: (required) How Long? SSN#: Telephone: (required) Are you at least 18 years of age?—Please choose an option—YesNo Your Email: (required) EMPLOYMENT DESIRED Position(s) Applied For: (required) Employment Desired:FULL-TIME ONLYIndependent (1099) Contractor When are you available to start work? Do you have experience with heavy machinery operation?—Please choose an option—YesNo If yes, please explain experience: Do you have a CDL or other licenses/certifications? If so, please explain: If hired, would you have a reliable means of transportation to and from work?—Please choose an option—YesNo Are you able to perform all essential functions and duties?—Please choose an option—YesNo If no, please explain restrictions: Do you have any additional skills that should be considered?—Please choose an option—YesNo If yes, explain please provide the details: EDUCATION Type of School:—Please choose an option—High SchoolCollegeBusiness or Trade School Name of School: Location: Years Completed: Major & Degree: Type of School:—Please choose an option—High SchoolCollegeBusiness or Trade School Name of School: Location: Years Completed: Major & Degree: Type of School:—Please choose an option—High SchoolCollegeBusiness or Trade School Name of School: Location: Years Completed: Major & Degree: WORK EXPERIENCE Please list your work experience beginning with your current/most recent job held. Name of Employer: Job Title: Address: Reason for Leaving (be specific): Employment Dates: May We Call for Reference?—Please choose an option—YesNo List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company: Name of Employer: Job Title: Address: Reason for Leaving (be specific): Employment Dates: May We Call for Reference?—Please choose an option—YesNo List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company: Name of Employer: Job Title: Address: Reason for Leaving (be specific): Employment Dates: May We Call for Reference?—Please choose an option—YesNo List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company: Attach Resume: APPLICATION FORM WAIVER Please read each paragraph closely, and enter your name to act as your signature below: I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or any other document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. I hereby authorize Harcourt Shell to thoroughly investigate my references, work records, education, driving record, credit history, criminal background and other matters related to my suitability for employment. I further authorize the employers, schools and other references I have listed to disclose to Harcourt Shell any and all documents, transcripts, letters, reports and other information related to these references, without giving me prior notice of such disclosure. I hereby release Harcourt Shell, my former employers, and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosures. I understand that nothing contained in the application, or conveyed during any interview which may be granted, or during my employment, if hired, is intended to create an employment contract between me and Harcourt Shell, other than one that is “at will.” I understand and agree that if I am employed, my employment will be of an “at will” nature, whereby either the employee or the employer may terminate the employment relationship at any time, with or without cause or notice. I further understand that my employment, if hired, is for no definite or determinable period of time and may be terminated at any time, at the option of either myself or Harcourt Shell, and that no promise or representation contrary to the foregoing is binding on the company unless made in writing and signed by me and the company’s designated representative. Signature of Applicant: Date: Harcourt Shell is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age, or disability. We assure you that your opportunity for employment with Harcourt Road Shell depends solely on your qualifications. Thank you for completing this application and for your interest in our business. [recaptcha]
