Employment Application

PERSONAL INFORMATION

Are you over the age of 18? YesNo

Can you prove your U.S. Citizenship? YesNo If NO, please provide your Permanent Resident Card Number and Expiration Date

Do you have a DRIVER'S LICENSE? YesNo

Do you have reliable means of transportation to work? YesNo

Have you had any moving violations during the past three years? YesNo If YES, please explain.

Can you travel if a job requires it? YesNo

Are you able to pass a drug test today? YesNo

EDUCATION

Describe any specialized training you have, apprenticeship experience, skills, and extra-curricular activities you have participated in:

WORK EXPERIENCE

Start with your last/present job, then list your previous two employers. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements, and/or promotions while you worked at this company.
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements, and/or promotions while you worked at this company.
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements, and/or promotions while you worked at this company.

EMPLOYMENT COMMENTS, EQUIPMENT EXPERIENCE

Comments (include any gaps in employment):
Please list any equipment you have operated:

REFERENCES

Please list two work-related references.

MILITARY

Drug Testing

I understand that I may be required to submit a urine sample for drug screening purposes prior to completion of the employment process and, if hired, at any time during my employment. If I refuse, or if I do not comply with testing procedures, I understand that I will not be considered for employment or may be subject to termination. I understand that if my urine screens positive for illegal substances and/or prescription drugs, whose use has not been prescribed by a licensed physician, I will not be considered for employment or may be subject to discharge. I consent to the release of drug testing records to this company.

Access to Records

I authorize investigation of all matters and records which the company deems relevant to my qualifications for employment, including all statements contained in this application, and I release from all liability any persons or employers providing such information, and I also release the company from all liability which might result from making the investigation.

Applicant's Statement

I understand that any employment offered by this firm is an "at will" nature, meaning that I may quit at any time, and the company may discharge me at any time, with or without cause, and that, if hired, I am required to abide by all rules and regulations of this company. I understand that this application will be active for 60 days; and if I want to be considered for a job at that time, I must apply by completing a new application form. I certify that the answers given on this application are complete and true to the best of my knowledge. I understand that falsification, misrepresentation or omission of facts in this application or any required document as well as misleading statements, will be cause for denial or employment or immediate termination regardless of how discovered.

SIGNATURE

By typing your name into the "Enter Electronic Signature" text field and clicking "Confirm Signature", you are certifying that all information provided to Brown Contracting is true and accurate.

Electronic Signature: Confirm Signature: