Job Application

Application Information

Date *

Name *

Apatment/Unit#

City *

State *

Zip *

Street *

Phone *

Email *

Are you eligible to work in the U.S? *

Yes

No

Are you at least 18 years or older? (If no, you may be required to provide authorization to work.) *

Yes

No

Date available to start *

Position Applied For

Hourly rate/Salary desired

If you are applying for a driving position, do you posess a valid NYS driver's licence?

Yes

No

What class license do you have?

Are you currently employed? *

Yes

No

If so, may we inquire of your present employer? *

Yes

No

How did you hear about us?

Have you ever worked for this company? *

Yes

No

If Yes, When?

Education

High School

Did You Graduate?

Yes

No

Address

Degree received

College

Did You Graduate?

Yes

No

Address

Degree received

Other:

Did You Graduate?

Yes

No

Address

Degree received

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain. *

Employment History

Company 1 *

Contact Person *

Address

Phone *

Job Title

Dates From - To *

Responsibilities *

Reason for Leaving *

Company 2

Contact Person

Address

Phone

Job Title

Dates From - To

Responsibilities

Reason for Leaving

Company 3

Contact Person

Address

Phone

Job Title

Dates From - To

Responsibilities

Reason for Leaving

References

Give the names of three persons not related to you, whom you have known at least three (3) years:

Name *

Phone *

Address *

Company *

Name

Phone

Address

Company

Name

Phone

Address

Company

Disclaimer and Signature

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Lake Shore Paving to hire me. If I am hired, I understand that either Lake Shore Paving or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Lake Shore Paving has the authority to make any assurance to the contrary. I attest with my signature below that I have given to Lake Shore Paving true and complete information on this application. No requested information has been concealed. I authorize Lake Shore Paving to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

Signature *

Date *

Employment Application

Application Information

Education

Employment History

References

Give the names of three persons not related to you, whom you have known at least three (3) years:

Disclaimer and Signature