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1900 Southern Blvd - Parsons, KS 67357
(Phone) 620.421.4670 | (Fax) 620.421.4430 | (Phone) 620.421.3280
E-mail machmaint@terraworld.net | khwicker@valnet.net
Today's Date:
Valid Email:
Desired Position:
Reffered By:
First Name: Middle: Last Name:
Address:
City, State, Zip
Phone Number: Alternate Number:

PERSONAL INFORMATION
Social Security Number:
Are You Over 18? Yes No
Are there any times during which you can not be available to work?
Weekdays Weekends Evenings Nights Overtime
Please explain if you can not be available at all times.
Can you travel if a job requires it? Yes No
What languages do you speak fluently? (Check all that apply)
English | Spanish | Other

GENERAL INFORMATION
Do you have a valid driver's license? Yes No
If yes, what is your driver's license number?
State: Class: Expiration Date:
Are you a veteran? Yes No
Have you ever been convicted of a crime? (besides a traffic violation) Yes No
If yes, Please explain: (you may speak confidentially with someone if your prefer)
Have you ever worked for our company before? Yes No
If yes, when?
Do you know anyone working for our company? Yes No
If yes, who?
Is there anything we can do to reasonably accomodate any special need or disability you may have? Yes No
If yes, please explain?

EXPERIENCE
Operator:
Bulldozer Motor Grader Scraper Loader
Crane Backhoe Roller Other
Operator Years Of Experience: years
Craft Worker:
Carpenter Form Builder Pipe Layer Concrete Finisher
Craft Worker Years Of Experience: years
Laborer:
Heavy Light
Laborer Years Of Experience: years
Shop Worker:
Welder Mechanic Heavy Equipment Auto
Shop Worker Years Of Experience: years
Truck Driver:
Trucks Truck Tractors Semi Trailers Full Trailers
Truck Driver Years Of Experience: years
Clerical:
Receptionist Payroll Accounts Payable Computer
Human Resources Benefits
Clerical Years Of Experience: years
Other:

Other Years Of Experience: years

EMPLOYMENT HISTORY
1. Name of Employer:
Address: City: Phone:
Name of Supervisor: Your Position:
Dates Employed: from to
Reason For Leaving:
 
2. Name of Employer:
Address: City: Phone:
Name of Supervisor: Your Position:
Dates Employed: from to
Reason For Leaving:
 
3. Name of Employer:
Address: City: Phone:
Name of Supervisor: Your Position:
Dates Employed: from to
Reason For Leaving:
 
4. Name of Employer:
Address: City: Phone:
Name of Supervisor: Your Position:
Dates Employed: from to
Reason For Leaving:
 
5. Name of Employer:
Address: City: Phone:
Name of Supervisor: Your Position:
Dates Employed: from to
Reason For Leaving:

REFERENCES
Please list (3) other people who are familiar with your work.
1. Name: Address: Phone:
 
2. Name: Address: Phone:
 
3. Name: Address: Phone:

EDUCATION

Grade Completed:
High School: City: State:
Diploma? Yes No | Year Recieved Diploma:
Special Education Or Training


COMMENTS
Please use this section for any comments you may have regarding employment with our company.
IF YOU HAVE A RESSUME', PLEASE MAIL, EMAIL OR BRING IT IN
PLEASE READ THE FOLLOWING CAREFULLY
This company requires all employees to submit to random drug testing. The employee must have results showing that there are no drugs in his/her system. This company may perform a BACKGROUND CHECK which include checking references and criminal history. Before any applicant begins work he/she will be required to go through a COMPANY ORIENTATION which will describe in detail basic safety requirements as well as the benefits offered. This company is an EQUAL OPPORTUNITY EMPLOYER that does not discriminate on the basis of sex, race, color, national origin, age, religion, or sexual orientation. Further, this company ensures that its employees are treated without discrimination in regards to the above criteria. This company maintains an EMPLOYMENT AT WILL status with all its employees. This means an employee may be terminated at any time for good cause, bad cause, or no cause at all.
 
This certifies that this application was completed by me, and all enteries on it and information in it are true and complete to the best of my knowledge. I understand that I may be terminated if I have falsified any information on this application. I agree to abide by the company policy as explained above and will not discriminate against any co-worker should I become employed
 

Digital Signature of Applicant

Corporate
1900 Southern Blvd.
Parsons, KS 67356
620.421.3280
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Member Specialized Carriers & Rigging Association
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Contact us | 620.421.3280
1900 Southern Blvd. • Parsons, KS 67357