Employee Application Sheet
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E.J. Wade Construction Application Sheet
P.O. Box 638 / Mechanicsville, Virginia 23111
Phone: 804.779.4882 / Fax: 804.779.7343
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For Office Use Only. |
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Hire: |
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Title:
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HR:
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Controller:
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Insurance:
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Management: |
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A. PERSONNAL INFORMATION
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Name *
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Nickname *
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Address *
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Home Number *
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Mobile Number
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Email Address *
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Email Address Confirmation *
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Date of Birth *
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Social Security Number *
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How did you hear about us? *
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Shirt Size *
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B. AVAILABILITY
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Today's Date *
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Date Available to Start *
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Looking For *
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Full Time
Part Time
Flexible
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Position Applying For *
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Travel Availability *
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Out of Town
Out of State
I will go
wherever is needed
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C. EMPLOYMENT HISTORY
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Most Recent Employer
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Company *
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Phone Number *
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Job Title *
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Start Date *
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End Date *
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Salary *
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Supervisor's Name *
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Duties *
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Reason for Leaving *
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Second Most Recent Employer
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Company *
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Phone Number *
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Job Title *
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Start Date *
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End Date *
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Salary *
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Supervisor's Name *
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Duties *
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Reason for Leaving *
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Third Most Recent Employer
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Company *
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Phone Number *
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Job Title *
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| Start Date * |
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End Date *
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Salary *
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Supervisor's Name *
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Duties *
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Reason for Leaving *
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D. EXPERIENCE
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Transportation and License Information
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Do you have a reliable mode of transportation? *
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Yes
No
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If the job requires, do you have a valid appropriate
drivers license? *
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Yes
No
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If "Yes", what type of license?
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CDL - Class A
CDL - Class B
CDL - Class C
Standard Drivers
License
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Driver's License Number
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State Issued
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CDL Information (please skip down to "Background Information" if this does not apply to you.)
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Trailer Experience
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Flatbed
Lowboy
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Do you have any experience transporting &
loading/unloading heavy equipment?
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Yes
No
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If "Yes", how many years experience?
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Background Information
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Have you had any moving violations in the past 3 years?
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Yes
No
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If "Yes", please answer the following for the past three years.
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Number of Tickets
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Describe
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Number of Accidents
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Describe
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Number of DWI/DUI
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Describe
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Number of Misdemeaner
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Describe
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Have you ever had your license suspended?
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Yes
No
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If "Yes", please describe
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Experience
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How many months/years of experience do you have
in the position you are applying for? *
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What types and makes/models of construction
equipment can you operate? *
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Please list any types of equipment you have
maintenance and repair experience with *
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List any craft training programs in which you have
participated in or any certifications you have
obtained *
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Are you currently CPR and/or First Aid Certified? *
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Yes
No
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If "Yes", please list expiration dates: CPR Expires *
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First Aid Expires *
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Do you have your own craft tool, clothing, and
other equipment? *
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Yes
No
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Are you fluent in a language other than English? *
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Please list any other special qualifications that you
have that may be helpful for us to know? *
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E. EDUCATION
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High School
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School Name *
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Course of Study *
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Last Year Attended *
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Graduation Date *
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College
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School Name
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Course of Study
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Last Year Attended
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Graduation Date
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Trade/Vocational School
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School Name
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Course of Study
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Last Year Attended
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Graduation Date
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Other
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Institute
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Course of Study
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Last Year Attended
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Graduation Date
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F. EMERGENCY INFORMATION
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Emergency Contact 1
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Name *
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Relationship *
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Phone Number *
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Address *
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Emergency Contact 2
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Name *
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Relationship *
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Phone Number *
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Address *
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If Applicable
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Spouse's Name
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Children's Names
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Allergies
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Special Health Conditions
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G. SECURITY
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Have you ever been convicted of a felony? *
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Yes
No
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If "Yes", please describe *
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Incident Date *
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City/State *
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| H. APPLICATION VERIFICATION |
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"I certify that the facts contained in this 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, and I agree to hold my employer harmless in the event of my dismissal based thereon. I authorize investigation of all statements
contained herein and to do background checks to give you all information concerning my previous employment and any pertinent information they may have, confidential or otherwise, and
release all parties from liability for any damage that may result from furnishing same to you. I realize that pre-employment drug testing could be a condition of my employment.I realize
that pre-employment drug testing will be a condition of my employment. I also acknowledge that the employer may require drug testing at a subsequent time. I also recognize that I could be
offered employment subject to appropriate medical examination and that such a report could nullify my ultimate employment by this employer. I agree to submit to physical examination if
required. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the method of payment of my wages and salary, be terminated at any time
without prior notice. If employment is obtained under this application, I will comply with all the rules and policies of my employer."
By signing below you agree that you have read and understand the above statement and that all the information included on this application is true to the best of your
knowledge.
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Digital Signature *
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Date *
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Actual Signature
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Your signature will be required at the time of interview.
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Date
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Image Verification
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