We are an Equal Opportunity Employer

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

PERSONAL INFORMATION

First Name

Middle Initial

Last Name

Home Address

City

State

Zip Code

Home Phone #

Cell Phone #

Email Address

Position(s) you are applying for:

Date you are available for work:

Are you currently employed? YesNo

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

Driver's License Number:

State of Issue:

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

High School

Name

Address

Date Completed

Courses of Study

University / College

Name

Address

Date Completed

Major/Degree

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

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.

Employer #1

Employer Name

Address

Supervisor's Name

Telephone #

May we contact this employer?
YesNo

Dates of Employment (from-to)

Pay / Salary

Your last Job Title

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.

Employer #2

Employer Name

Address

Supervisor's Name

Telephone #

May we contact this employer?
YesNo

Dates of Employment (from-to)

Pay / Salary

Your last Job Title

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.

Employer #3

Employer Name

Address

Supervisor's Name

Telephone #

May we contact this employer?
YesNo

Dates of Employment (from-to)

Pay / Salary

Your last Job Title

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 references other than relatives or previous employers.

Name

Relationship

Telephone #

Name

Relationship

Telephone #

MILITARY

Branch of Service

Reserve Organization

Final Rank

Date Entered

Discharge Date

Training Specialty

Serial Number

Branch of Service

Reserve Organization

Final Rank

Date Entered

Discharge Date

Training Specialty

Serial Number

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: