APPLICATION FOR EMPLOYMENT

This form complies with federal and state laws against discrimination; however, employers using this form should check local ordinances. HuxCo Construction is not responsible for the misuse of information provided on this form. Provide all information requested by printing in ink or typing. Use the 'TAB' key to move through the document.

GENERAL INFORMATION

Name (Last)
(First)
(Middle Initial)
Home Telephone
Address (Mailing Address)
(City)
(State)
(Zip)
Other Telephone
E-Mail Address
Are you legally entitled to work in the U.S.?  
Yes   No

POSITION

Position Or Type Of Employment Desired
Are you able to perform the essential functions of the job you are applying for, with or without reasonable accommodation?  
Yes   No
Will Accept:
Part-Time
Full-Time
Temporary
Shift:
Day
Swing
Graveyard
Rotating
Salary Desired
Date Available

EDUCATION AND TRAINING

High School Graduate Or General Education (GED) Test Passed?  
Yes   No
If no, list the highest grade completed

College, Business School, Military (Most recent first)

Name and Location
Dates Attended Month/Year
Graduate   Yes   No
Degree & Year
Major or Subject
Credits Earned
Quarterly or Semester Hours
Other (Specify)
Name and Location
Dates Attended Month/Year
Graduate   Yes   No
Degree & Year
Major or Subject
Credits Earned
Quarterly or Semester Hours
Other (Specify)
Name and Location
Dates Attended Month/Year
Graduate   Yes   No
Degree & Year
Major or Subject
Credits Earned
Quarterly or Semester Hours
Other (Specify)
Name and Location
Dates Attended Month/Year
Graduate   Yes   No
Degree & Year
Major or Subject
Credits Earned
Quarterly or Semester Hours
Other (Specify)
Occupational License, Certificate or Registration
Number
Where Issued
Expiration Date
Occupational License, Certificate or Registration
Number
Where Issued
Expiration Date
Occupational License, Certificate or Registration
Number
Where Issued
Expiration Date
Languages Read, Written or Spoken Fluently Other Than English

VETERAN INFORMATION (Most recent)

Branch of Service
Date of Entry
Date of Discharge

SPECIAL SKILLS (List all pertinent skills and equipment that you can operate)

(Maximum 1000 characters)

WORK EXPERIENCE (Most Recent First)
(Include voluntary work and military experience)

Employer
Telephone Number
Address
Job Title
Number Employees Supervised
From (Month/Year)
To (Month/Year)
Hours Per Week
Last Salary
Supervisor
Specific Duties (Maximum 1000 characters)
Reason For Leaving
May We Contact This Employer?  
Yes   No
Employer
Telephone Number
Address
Job Title
Number Employees Supervised
From (Month/Year)
To (Month/Year)
Hours Per Week
Last Salary
Supervisor
Specific Duties (Maximum 1000 characters)
Reason For Leaving
May We Contact This Employer?  
Yes   No
Employer
Telephone Number
Address
Job Title
Number Employees Supervised
From (Month/Year)
To (Month/Year)
Hours Per Week
Last Salary
Supervisor
Specific Duties (Maximum 1000 characters)
Reason For Leaving
May We Contact This Employer?  
Yes   No
Employer
Telephone Number
Address
Job Title
Number Employees Supervised
From (Month/Year)
To (Month/Year)
Hours Per Week
Last Salary
Supervisor
Specific Duties (Maximum 1000 characters)
Reason For Leaving
May We Contact This Employer?  
Yes   No

I certify the information contained in this application is true, correct, and complete. I understand that, if employed, false statements reported on this application may be considered sufficient cause for dismissal.

Full Name
Date
Interviewer’s Comments:

HuxCo Construction is an equal opportunity employers and providers of employment and training services. Auxiliary aids and services are available to persons with disabilities upon request.

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