Earthworks Grading and Paving LLC
1. Employer Information
Employer: Earthworks Grading and Paving LLC
Address: 5081 North Pioneer Way UNIT C
City/State/ZIP: Las Vegas, Nevada 89149
Telephone: 725.278.1958
It is the policy of Earthworks Grading and Paving LLC to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability, or veteran status.
2. Applicant Information
Applicant Full Name:
Home Address:
City/State/ZIP:
Number of years at this address:
Daytime Phone:
Evening Phone:
Mobile Phone:
Social Security Number:
DOB:
Driver's License (State/Number):
3. Emergency Contact
Who should be contacted if you are involved in an emergency?
Contact Name:
Relationship to you:
Address:
4. Job Position Applied For:
5. Salary Desired: $ per
6. Who referred you to our company?
Do you have any friends or relatives who work here? If yes, please list here:
7. Are you at least 18 years old?
YesNo
8. Are you willing to work any shift, including nights and weekends?
If no, please state any limitations:
9. If applicable, are you available to work overtime?
10. If you are offered employment, when would you be available to begin work?
11. If hired, are you able to submit proof that you are legally eligible for employment in the United States?
12. Position you are applying for
Super IntendantForemanOperatorLaborer
Skills- List most revealing that pertain to the position you are apply for here
+ Add Skill
If you are applying for a equipment operator position,list the Equipment below, starting with what you are most skilled on.
+ Add Equipment
Check all that apply
Able to lift 50 lbsProficient in use of sloping lasersSkilled with hand levelCan read and understand civil drawings
OSHA CARD (check all that apply)
OSHA10OSHA30OSHA80
13. Employment History
Please list your most recent employment first. Include all jobs (including self-employment and military service).
Employer 1 (Most Recent)
Employer Name:
Supervisor Name:
Job Duties:
Reason for Leaving:
Dates of Employment:
Employer 2
Employer 3
14. Applicant's Education and Training
College/University Name and Address
Did you receive a degree?
YesNo If yes, degree(s) received:
High School/GED Name and Address
Other Training (graduate, technical, vocational):
Please indicate any current professional licenses or certifications that you hold:
Awards, Honors, Special Achievements:
Military Service:
Branch:
Specialized Training:
15. References
List any two non-relatives who would be willing to provide a reference for you.
Reference 1
Name:
Telephone:
Relationship:
Reference 2
16. Additional Information
Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:
I certify that the information provided is truthful and accurate. I understand that providing false or misleading information will be the basis for the rejection of my application or, if employment commences, immediate termination.
I authorize Earthworks Grading and Paving LLC to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.
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