Employment

Personal Information
First:			Middle:		Last:
Present
Address:
City:			State:		Zip:
Permanent
Address:
City:			State:		Zip:
Day Phone:				Night Phone:
E-Mail:
Referral:
Are you 18 years of age or older: Yes No
Employment Requesting
Position:			Date you can start:			Salary Desired:
Currently Employeed: Yes No				If So May We Inquire of Your Present Employer?: Yes No
Education
		Name of School		Location		Year	Grade Completed
High School:
College:
Trade/Speciality:
General
Subject of Special Study or Research Work:
Job related skills (typing, driver’s license, etc):
Reference (List below three person not related to you, whom you have known at least one year.)
		Name		Address		Years Acquainted	Position
1:
2:
3:
Former Employers (List below your last four employers, starting with the last one first.)
Date (month/year)		Employer		Address		Salary (Upon Leaving)	Position
From	/
To	/	Reason for Leaving:
From	/
To	/	Reason for Leaving:
From	/
To	/	Reason for Leaving:
From	/
To	/	Reason for Leaving:
If you are to be hired by the company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements
AUTHORIZATION
I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Harding Road Boring, Inc. I understand that any employment is conditioned on a background check. I authorize the Harding Road Boring, Inc. to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to Harding Road Boring, Inc., without giving me prior notice of such disclosure. In addition, I release Harding Road Boring, Inc., any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure. I understand and agree that nothing contained is this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be "at will" and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me, and I understand that no such promises or guarantee is binding upon Harding Road Boring, Inc. unless made in writing. If I am offered employment I agree to submit to as medical examination and drug test before starting work. If employed, I also agree to submit to a medical examination of drug test at any time deemed appropriate by Harding Road Boring, Inc. and as permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to Harding Road Boring, Inc. the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test, and if I am hired a condition of my employment will be that abide by Harding Road Boring, Inc. Drug and Alcohol Policy. ...I certify that I do not have any detectable amounts of prohibited substances in my system at the time of taking my pre-employment drug screen. I understand that if my drug screen turns out positive for a prohibited substance, I will not be eligible for hire, or if I am hired pending the outcome of such a test, I will be subject to immediate termination. I understand that filling out this form does not indicate there is a position open and does not obligate Harding Road Boring, Inc. to hire. If hired, I agree to abide by Harding Road Boring, Inc. work rules, policies and procedures. Harding Road Boring, Inc. retains the right to revise it policies or procedures, in whole or in part, at any time.
Submit

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