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Asphalt and Concrete Manufacturing
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If you wish to apply for a position with Summers-Taylor, you can fill out the the form below or you can download a pdf of the application to fill out and mail to us.
Personal Information
Name
*
Home or Nearest Phone
*
Social Security Number
*
Current Address
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
*
If at current address less than one year, please give previous address
Are you at least 18 years of age?
*
Yes
No
(Employment is subject to verification of minimum legal age.)
Position(s) applied for:
*
Concrete Dispatcher
Other
How soon could your report to work?
*
Type of employment desired
*
Full-Time
Part-Time
Temporary
Rate of pay expected
What days and hours if part time?
Education
Elementary School (check last year completed)
*
5
6
7
8
High School
*
9
10
11
12
College
1
2
3
4
Post Graduate
Have you applied for a job with us before?
*
Yes
No
Have you ever worked for us before?
*
Yes
No
How did you come to apply?
*
Employee Referral
Former Employee
Newspaper Ad
High School Recruitment
College Recruitment
Walk-In
Other
If other
Have you ever been bonded?
*
Yes
No
Have you ever been refused a bond?
*
Yes
No
If yes, state reason and date
Have you ever been convicted of a violation of the law except a minor traffic violation?
*
Yes
No
If yes, state date, court and place where offense occured.
(A conviction will not necessarily disqualify you from employment.)
Have you ever been discharged or requested to resign from a position?
*
Yes
No
Are you employed now?
*
Yes
No
If yes, may we contact your present employer?
Yes
No
Have you ever held a position of trust (handling money or confidential material)?
*
Yes
No
If yes, please describe
Do you have any reason to believe that you would have difficulty meeting this company's work schedules?
*
Yes
No
Prior Work Record
Start with the most recent or present employer and complete in full
1. Name and address of most recent employer
*
Phone number
*
Immediate Supervisor (Name & Position)
*
Date hired
*
Date Left
Starting Rate
Last Rate
Reason for leaving?
May we contact this employer?
*
Yes
No
2. Name and Address of Former Employer
*
Phone number
Immediate Supervisor (Name and Position)
Date Hired
Date Left
Starting Rate
End Rate
Reason for leaving?
May we contact this employer?
Yes
No
3. Name and Address of Former Employer
Phone Number
Immediate Supervisor (Name & Position)
Date Hired
Date Left
Starting Rate
Reason for leaving?
Last Rate
May we contact this employer?
Yes
No
References
Do not list relatives or former employers
Reference 1 (Name, Address & Telephone)
*
Reference 2 (Name, Address & Telephone)
*
Reference 3 (Name, Address & Telephone)
*
Job Applicant's Agreement and Certification
“I certify that the information given by me in this application is true in all respects, and I agree that if the information given is found to be false in any way, it shall be considered sufficient cause for denial of employment or discharge. I authorize the use of any information in this application to verify my statements, and I authorize past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information.” “I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between the company and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the company unless made in writing. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and that the company retains the same right.” “If I am offered employment, I agree to submit to a physical examination whenever requested, and I understand my becoming employed and/or my continued employment are subject to the results of any physical examination related to my job duties in accordance with company policies and procedures.” “I understand that if employed, policies, and rules which are issued are not conditions of employment and that the employer may revise policies or procedures in whole or in part, at any time.” “I understand that this application will be kept on active file for 90 days from the date completed, after which time I would have to reapply in accordance with established company procedures.”
Type your initials to indicate acceptance of above agreement
*
Date
*
*) Required fields
