Superior Construction - Application for Employment

APPLICATION FOR EMPLOYMENT
Pre-Employment Questionnaire-Equal Opportunity Employer
"We are a Drug Free Workplace"
Personal Information
First Name:
Last Name:
Social Security Number:
Address:
City:
State:
Zip:
Prior Address:
Prior City:
Prior State:
Prior Zip:
Telephone Number:
Email Address:
Referred By:
Where are you applying from?

Employment Information
Position: (select top 2 desired)
Date you can start:
Desired Salary:	$ per Hour

Are you currently employed?	Yes No
If so, may we contact your current employer?	Yes No
Have you ever applied to Superior before?	Yes No
If yes, When/Where?

Education:

Select the highest grade completed:
Name of High School	City/State	Graduate?	Degree?
		Yes No	Yes No
Name of College	City/State	Graduate?	Type of Degree?
		Yes No
Other Education	City/State	Graduate?	Degree Type?
		Yes No

Job Related Skills: Note: DO NOT complete any part you believe to be non-job related.
Do you fluently speak any other non English language?	Yes No
If so, please list:
If the job requires, do you have the appropriate valid driver's license?	Yes No
What state is your driver's license issued in?
What type of driver's license do you have?
If your driver's license is a commercial driver's license, what type?
What is your driver's license number?
Have you had any moving violations?	Yes No
If so, please explain:
Have you ever been enlisted in the U.S. Military or Naval Service?	Yes No
If so, what was/is your rank?
Please list any special subject of study, special training or skills.

References: (Include only individuals familiar with your work ability. No relatives)
	Name	Address/Phone	Years Known/Relationship
1
2
3

Employment History
Most Recent Employer
May we contact this employer?		Yes No
Company Name:		Phone:
Employment Dates:	to	Fax:
Duties:		Salary:
Supervisor:		Reason for leaving:

Second Most Recent Employer
May we contact this employer?		Yes No
Company Name:		Phone:
Employment Dates:	to	Fax:
Duties:		Salary:
Supervisor:		Reason for leaving:

Third Most Recent Employer
May we contact this employer?		Yes No
Company Name:		Phone:
Employment Dates:	to	Fax:
Duties:		Salary:
Supervisor:		Reason for leaving:

Additional Comments:

CERTIFICATION AND RELEASE

Please read the following and check "I Agree" below.

I certify that I have read and understand this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information. I authorize all former employers, persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

Yes I Agree I do not Agree

APPLICATION FOR EMPLOYMENT