Date of Application:     Position Applied For:   

 Location:

    PERSONAL INFORMATION

    Last Name: First Name: Middle Initial:

    Present Address:   Street:     
                                    City: State: Zip:

    Residence Telephone Number:     Alternative Contact Phone Number:

    1.    Are you authorized to work in the United States?      Yes:     No
    2.    Are you 18 years of age or older?                            Yes:     No:
    3.    Have you worked with us before?                            Yes:     No:

    If you answered yes to question number 3 above, please state when, where, what project and your immediate supervisor:
   

    List any friends or relatives other than your spouse currently working for Park Construction:   

    EDUCATION

    High School:        G.E.D.        Trade/Business School:         College:         Other:    

    School 1:        Name:     City:      State:
                          No. of Years:     Graduate:    Yes: No:
                          Subject/Degree:  

   School 2:        Name:     City:      State:
                          No. of Years:     Graduate:    Yes: No:
                          Subject/Degree:  

    List an special qualifications, licenses or other information which may help qualify you for the position:
   

    List all the pieces of equipment or machinery you can operate:
   

    WORK HISTORY

    CURRENT OR LAST EMPLOYER

    Please enter dates. From:     To:
    Employer's Name: Nature or Type of Business:

    Employer's Address:      Employer's Phone Number:  

    The Title or Position You Held:     Starting Pay Rate: Ending Pay Rate:

    Supervisor: May we contact your current/former employer?     Yes:     No:

    NEXT PREVIOUS EMPLOYER

    Please enter dates. From:     To:
    Employer's Name: Nature or Type of Business:

    Employer's Address:      Employer's Phone Number:  

    The Title or Position You Held:     Starting Pay Rate: Ending Pay Rate:

    Supervisor: May we contact your current/former employer?     Yes:     No:

    NEXT PREVIOUS EMPLOYER

    Please enter dates. From:     To:
    Employer's Name: Nature or Type of Business:

    Employer's Address:      Employer's Phone Number:  

    The Title or Position You Held:     Starting Pay Rate: Ending Pay Rate:

    Supervisor: May we contact your current/former employer?     Yes:     No:

    REFERENCES

    Give the names of two people not related to you whom you have known at least one year.

    Name:        Address: Occupation:

    Telephone Number:

    Name:        Address: Occupation:

    Telephone Number:

    AFFIRMATIVE ACTION SURVEY

    As an employer/government contractor, we must comply with government regulations and affirmative action responsibilities. The information requested below will be used to determine if our recruitment efforts are reaching all segments of the community and will meet our reporting requirements. The information will be used and kept confidential in accordance with the applicable laws and regulations.

NOTE: COMPLETION OF THIS QUESTIONNAIRE IS VOLUNTARY AND REFUSAL TO PROVIDE INFORMATION WILL NOT HAVE A NEGATIVE EFFECT ON YOUR STATUS AS AN APPLICANT.

    Check One:     Male:     Female:

    Check one of the following:

        Your Race/Ethnic Group    White        Black        Hispanic        American Indian/Alaskan Native    Asian/Pacific Islander

    Check any of the following that are applicable:

        Vietnam Era Veteran        Disabled Veteran          Disabled Person (not a veteran)
        Other Eligible Veteran    
                List Qualifying Campaign/Expedition  
                        (Click here for options)

APPLICATION'S CERTIFICATION AND AGREEMENT

I understand that when I submit this form on line I certify that he facts set forth in this Employment Application are true and complete to the best of my knowledge. I understand that falsification, omissions or misstatements may prevent my being hired, or if already hired, may subject me to dismissal. I authorize Park Construction Company to make a thorough investigation of my entire work history, and to verify all data given in my application for employment. I release from liability any person giving or receiving information regarding my personal history, medical information and prior work record. I understand and agree that my employment is for no definite period of time and may be terminated by this company at any time without liability for wages or salary except such as may have been earned at the date of termination. I understand that, if hired, I will abide by all the rules and regulation of Park Construction Company.