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Are you over 18 years old? *
Are you legally eligible for employment in this country? *
Have you ever been employed by A&A Construction & Utilities, Inc.? *
If so:


Employment Desired


Are you currently employed? *
If currently employed, can we contact your current employer? *
Can you work nights? *
Can you work weekends? *


Driving History


Do you have a driver’s license? *
Is your license currently suspended or revoked? *
Do you have a commercial driver’s license (CDL)? *
Have you had any accidents in the past three years? *
Have you had any moving violations during the past three years? *
Have you ever been denied a license, permit or privilege to operate a motor vehicle? *
Have you ever had a license, permit or privilege suspended or revoked? *
Have you operated a commercial vehicle in excess of one year? *
Have you ever been convicted of a felony? *







Please list three personal references other than relatives or previous employers:


Employment History


List your last four employers, starting with your current or most recent, including military service.

May we contact your former employers? *


Employer #1


Hourly Rate/Salary:


Employer #2


Hourly Rate/Salary:


Employer #3


Hourly Rate/Salary:


Employer #4


Hourly Rate/Salary:



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"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA} and/or relevant federal and state laws."

*By signing below, you "CERTIFY" that the above information is correct.