Employment ApplicationStep 1 of 4 - Personal Information25%Name* First Last Email* Phone*Address* Street Address Address Line 2 City State / ProvinceAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you have a valid driver's license?*Select oneYesNoDo you have reliable transportation to meet any scheduled shift?*Select oneYesNoDid anyone refer you to B&Z Company?*Select oneYesNoWho referred you? First Last Have you ever operated heavy equipment, such as a backhoe?*Select oneNoYesPlease describe the equipment operated:Do you have any certifications, qualifications, special skill, or specialized training which may benefit you in the position for which you are applying? If so, please describe.Do you have a legal right to work in the U.S.?*Select oneYesNoCan you provide documentation of your legal right to work?*Select oneYesNoFor what position are you applying?*Would you accept another position?*Select oneYesNoDate available to start?* MM slash DD slash YYYY If hired, do you have any immediate scheduling conflicts?*Work HistoryCompanyHire Date MM slash DD slash YYYY Date LeftJob TitleReason for LeavingStarting Hourly RateFinal Hourly RateSupervisor's Name First Last Supervisor's PositionSupervisor's Phone NumberMay we contact this employer?YesNoMajor Responsibilities and Accomplishments:Additional Work History 1CompanyHire Date MM slash DD slash YYYY Date LeftJob TitleReason for LeavingStarting Hourly RateFinal Hourly RateSupervisor's Name First Last Supervisor's PositionSupervisor's Phone NumberMay we contact this employer?YesNoMajor Responsibilities and Accomplishments:Additional Work History 2CompanyHire Date MM slash DD slash YYYY Date LeftJob TitleReason for LeavingStarting Hourly RateFinal Hourly RateSupervisor's Name First Last Supervisor's PositionSupervisor's Phone NumberMay we contact this employer?YesNoMajor Responsibilities and Accomplishments:Additional Work History 3CompanyHire Date MM slash DD slash YYYY Date LeftJob TitleReason for LeavingStarting Hourly RateFinal Hourly RateSupervisor's Name First Last Supervisor's PositionSupervisor's Phone NumberMay we contact this employer?YesNoMajor Responsibilities and Accomplishments:I certify the information above is complete and accurate to the best of my knowledge. I authorize the individuals, companies and agencies concerned to provide this company and its agents with all information necessary to verify the statements I have made in this application and I release them from any liability for so doing. I understand I must receive satisfactory references from previous employers, co-workers and subordinates (if any) before an offer of employment can be made. I understand that incomplete or unsigned applications will not be considered and that false, incomplete or misleading statements are grounds for my immediate discharge. I understand that any offer of employment is contingent upon my passing a physical examination, proving my identity and documenting my right to work. I understand these policies cannot be changed except in writing. In consideration of my employment, I agree to conform to the rule and regulations of B&Z Company (the "Company"). I also acknowledge that my employment may be terminated, at any time, with or without cause, and with or without notice, at the option of the company. I understand that no representative of the company other than the company's President has any authority to enter into any agreement that will alter the at-will nature of any employment that I may obtain at the company, and no such agreement shall be binding on the company unless in writing and signed by the President of B&Z Company.Upload Resume (optional)Accepted file types: pdf, doc, docx, Max. file size: 5 MB.You may upload your Resume (PDF, DOC,DOCX)Initial as Electronic Signature:* First Last CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
