Employment Application

"*" indicates required fields

Step 1 of 6 - CONTACT INFORMATION/POSITION INTERESTED IN

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

Employer one

Employer Name:

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employed from:

Job Title

Immediate Supervisor and Title:

May we contact?

Hourly Rate/Salary:

Reason for leaving?

Summarize the nature of work performed and job responsibilities:

Employer Two

Employer Name:

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employed from:

Job Title:

Immediate Supervisor and Title:

May we contact?

Hourly Rate/Salary:

Reason for leaving?

Summarize the nature of work performed and job responsibilities:

Employer Three

Employer Name:

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employed from:

Job Title:

Immediate Supervisor and Title:

May we contact?

Hourly Rate/Salary:

Reason for leaving?

Summarize the nature of work performed and job responsibilities:

Employer Four

Employer Name:

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employed from:

Job Title:

Immediate Supervisor and Title:

May we contact?

Hourly Rate/Salary:

Reason for leaving?

Summarize the nature of work performed and job responsibilities:

Employer Five

Employer Name:

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employed from:

Job Title:

Immediate Supervisor and Title:

May we contact?

Hourly Rate/Salary:

Reason for leaving?

Summarize the nature of work performed and job responsibilities:

Employer Six

Employer Name:

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employed from:

Job Title:

Immediate Supervisor and Title:

May we contact?

Hourly Rate/Salary:

Reason for leaving?

Summarize the nature of work performed and job responsibilities:

Employer Seven

Employer Name:

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employed from:

Job Title:

Immediate Supervisor and Title:

May we contact?

Reason for leaving?

Summarize the nature of work performed and job responsibilities:

Special Skills

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

If yes, please explain:

Computer Skills (please describe):

References

List below three persons not related to you who have personal knowledge of your work performance within the last 5 years.

Name

First

Telephone No.

# Yrs Acquainted

Name

First

Telephone No.

# Yrs Acquainted

Name

First

Telephone No.

# Yrs Acquainted

Please Read Carefully, Initial Each Paragraph and Sign Below:

Should you be considered for hire, is there anything keeping you from starting with our company?

If yes, please explain:

Have you signed a non-compete agreement with any past employers?

If yes, please explain:

Please read carefully before signing. All County Paving is an equal opportunity employer. All County Paving does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for All County Paving to hire me. If I am hired, I understand that either All County 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 All County Paving has the authority to make any assurance to the contrary. I attest with my signature below that I have given to All County Paving true and complete information on this application. No requested information has been concealed. I authorize All County Paving to contact my references provided and to conduct background checks as needed for employment. I hereby release All County Paving from any/all liability of whatever kind and nature, which, at any time, could result from obtaining and having an employment decision based on such information. 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.

Date

Name

First Last

THIS APPLICATION IS VALID ONLY FOR 90 DAYS FROM THE DATE SIGNED/DATED ABOVE.

Notice to Applicants
All County Paving (The Company) has established and maintains a drug-free workplace program. This drug-free workplace program is in conformity with Chapter 440.102, Florida Statutes, its implementing regulations, and Federal law. As part of this program, offers of employment are expressly conditioned upon passing a drug test. In addition, employees of the Company may be subject to drug testing under those conditions outlined in the Company’s Drug and Alcohol Policy Statement. For a person receiving a conditional offer of employment, failure of a drug test or refusal to submit to drug testing when required by the Company shall cancel or terminate any job offer. For an employee, failing a drug test or refusing to submit to a drug test will result in action against any employee up to and including termination of employment. A person who receives a conditional offer of employment will have an opportunity to confidentially report to the Medical Review Officer (MRO) both before and after being tested regarding the use of prescription or non-prescription medications. Additionally, a job applicant shall receive a list of common medications which may alter or affect a drug test. A job applicant will also be given names, address, and telephone numbers of local alcohol and drug rehabilitation programs. Any person receiving a conditional offer of employment who fails a drug test may challenge or explain the result within five working days after written notification of the test result. A job applicant will also have an opportunity to request a retest at the job applicant’s expense. If a job applicant’s explanation or challenge is unsatisfactory, the job applicant may contest the drug test results pursuant to rules adopted by the Department of Labor and Employment Security of the Florida Agency for Health Care Administration. The job applicant also has the responsibility to notify the laboratory or clinic conducting the drug test of any administrative or civil action brought involving the drug test conducted by that laboratory or clinic. The job applicant also has a right to consult the testing laboratory or clinic for technical information regarding prescription and non-prescription medication. In addition, each job applicant will be given a list prior to administration of the drug test of the substances to be tested. All test results will remain confidential except as allowed by law. The Company will provide each job applicant with a copy of the Company’s Drug and Alcohol Abuse Policy Statement prior to the administration of a drug test. Nothing in this Notice will affect these rights provided in any collective bargaining agreement between the Company and its employees. Refusal to complete or sign this document will result in a withdrawal of any offer of employment.

Name of Company: All County Paving

I authorize you to release my motor vehicle record to All County Paving.

My Driver’s License #:

My Date of Birth:

Applicant Name:

Applicant Signature:

Date

Complete List of Drugs Tested
The Company may test for the following drugs:

Alcohol (beer, wine, booze, liquor, etc.)
Amphetamines (speed, eve, Biphetamine, Desoxyn, Dexedrine, etc.)
Cannabinoids (marijuana, hashish, hash, hash oil, pot, join, reefer, roach, spleaf, grass, weed, etc.)
Cocaine (coke, blow, snow, flake, crack, etc.)
Phencyclidine (PCP, angel dust, hog, etc.)
Hallucinogens (Quaaludes, ludes, etc.)
Opiates (heroin, codeine, morphine, opium, Dover’s powder, paregoric, parepecrolin, etc.)
Barbiturates (phenobarbital, butabarbital, secobarbital, tuinal, amytal, etc.)
Benzodiazepine (Librium, Valium, Arivan, Azene, Clonopin, Dalmone, Diozepam, Halcion, Poxipam, Restoril, Serax, Transene, Vertron, Xanax, etc.)
Synthetic narcotics, including methadone (dolophine, methadose, etc.)
Designer drugs (ecstasy, etc.)

CAPTCHA

Employment

Employment Application

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

List below levels of education completed.

High School

College or University

Trade or Business

Employer one

Employer Two

Employer Three

Employer Four

Employer Five

Employer Six

Employer Seven

Special Skills

References

Please Read Carefully, Initial Each Paragraph and Sign Below: