James A. Rogers Excavating, Inc

Job Application Form

Use the form below or click on the button to download the job application form to print and fill out

401K Available

Paid Vacation After 1 Year

Supplemental Insurance Offered

Annual Employee Recognition Award

About this Application
This Application Form is intended for use in evaulating your qualifications for employment. This is not an Employment Contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or if discovered after employment we will terminate employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, age creed, national origin, color, religion or presence of disabilities. A felony conviction will not necessarily bar an applicant from employment. Affirmative action hiring may be requested by qualified applicants. Additional testing of job related skills and drug testing may be required prior to employment.
Today's Date
Month - Day - Year
Personal Information
Last Name
MI
First Name
Home Phone
Phone Number
Mobile Phone
Phone Number
Email Address

Current Address

Prior Address

List States and Counties of Residence of Past Seven Years
Have you ever used any names for Social Security Numbers other than those on the application?
SSN
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Driver's License Violation History
If the job requires, do you have the appropriate valid Driver's License?

Yes No
Driver's License Number:
Driver's License Type
State
Have you had any moving violation?

Yes No
If Yes, please describe
Have you been convicted of a felony and/or served time in the past seven years?

Yes No
If so, describe below (in accordance with company policy, this information will be reviewed for job relatedness and time since last conviction)
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Job Related Skills & Requirements
Please list any other skills, licenses or certificates that may be job-related or that you feel would be of value to this job or company.
Have you been given a Job Description or had the requirements of the job explained to you?

Yes No
Do you understand the requirements?

Yes No
Can you perform the requirements of this job with or without reasonable accommodation?

Yes No
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Employment History
Please list your last three employers. Your application will not be considered unless every question is answered. Since we make every effort to contact previous employers, please be sure to provide correct contact/phone information
1 - Most Recent Employer
Are you currently working here?

Yes
No
If YES, may we contact?

Yes
No
Company Name
City
State
Phone
Job Title
To
Month - Day - Year
From
Month - Day - Year
Responsibilities/Duties
Supervisor's Name
Reason for leaving
Rate of Pay
Per Hour, Week or Month?

Hour Week Month
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Background Check & Drug Testing Authorization
I certify that I have read and understand the applicant note on Page 1 of this form and that the answers and statements given by me or complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentations of facts called for in this application may result in rejection of my application or discharge at anytime during my employment. I authorize the company, James A. Rogers, Inc., and/or it's agents to verify any of this information including, but not limited to criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release said persons, and hold non-liable for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs/substances is prohibited during employment. If the company requires, I am willing to submit to drug testing to detect the use of illegal drugs/substances prior to and during employment.
Applicant's Signature
Full Name
Date
Month - Day - Year
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