Personal Information Name: First, Middle, Last* Date Present Address* City, State, Zip* Phone Number* Mobile Email* Are you 18 years or older?* Yes No Does your immigration status permit you to accept employment lawfully, immediately and indefinitely?* Yes No Employment Position Information Position applied for: Date you can start:* Salary/Wage Desired: Do you have adequate transportation to work? Yes No Referred By: Do you have any relatives working for this company?* Yes No Have you ever been convicted of, or pled guilty to, no contest to, or received deferred adjudication for a felony or misdemeanor?* Yes No Military Service: Rank Acheived: Member of the Reserve or Guard Yes No State LIcense Number: Education History High School Name Years Attended Did you graduate? Major Course or Subject College or Trade School Name Years Attended Did you graduate? Major Course or Subject Other Education Name Years Attended Did you graduate? Major Course or Subject *The Age Discrimination Act of 1987 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age Record of Previous Employment Start - End Date Employer Name Employer Address Employer Phone Position Salary/Wage Reason for Leaving Start - End Date Employer Name Employer Address Employer Phone Position Salary/Wage Reason for Leaving Start - End Date Employer Name Employer Address Employer Phone Position Salary/Wage Reason for Leaving Which of these jobs did you like best and why? References List the names of three persons (not related) whom you've known for a least a year. Name Address & Phone Affliation Years Known Name Address & Phone Affliation Years Known Name Address & Phone Affliation Years Known Construction Experience In what areas do you have considerable experience? If your experience is limited please state so. Concrete Experience Form work (building and setting forms) Yes No Limited Reinforcing (placing & tying rebar, re-mesh) Yes No Limited Placement (puddling, screeding, striking) Yes No Limited Finishing (floating, bull floats, hand trowels) Yes No Limited Finishing (power troweling) Yes No Limited Carpentry Experience Wood frame construction Yes No Limited Rough carpentry Yes No Limited Finish carpentry Yes No Limited Shingling Yes No Limited Steel Erection Rigid frame metal building erection Yes No Limited Behlen s-span erection Yes No Limited Welding / fabrication Yes No Limited Millwright Yes No Limited Miscellaneous Reading blueprints Yes No Limited Using transits, automatic levels, theodolites Yes No Limited Equipment and Tools Powder actuated tools Yes No Limited Concrete saw Yes No Limited Tamper / jumping jack Yes No Limited Bobcats Yes No Limited Forklifts Yes No Limited Dump truck Yes No Limited Front end loaders Yes No Limited Crane Yes No Limited Lifts - boom and/or scissor Yes No Limited Please list any additional skills that you possess that you feel would be beneficial in considering your application for employment. Work Flexiblity In order to consider your application please answer the following questions. Are you able to work out of town for extended periods? (up to 2 weeks) Yes No Are you capable of lifting 50 pounds? Yes No Are you physically able to perform manual labor for extended periods? Yes No Are you able to work in extreme heat and cold? Yes No Are you available to work weekends? Yes No Are you willing to work over 1 story (10 ft) above the ground? Yes No Do you have a valid Nebraska driver’s license? Yes No Motor Vehicle Record Request Name: First, Middle, Last Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Driver’s License # State Date of Birth I hereby grant permission to Bierman Contracting, Inc. to obtain my motor vehicle record. Drivers Signature Date Why should Bierman Contracting, Inc. hire you? Please Read Carefully Before Signing I hereby give consent to any and all prior employers of mine to provide information with regard to my employment with any prior employers to Bierman Contracting, Inc. (lb959). I hereby certify that the information I have provided on this application (and any other document I have provided) is true, correct, and complete. I understand that any falsification, misrepresentation or omission in this application or hiring process will be sufficient ground for rejection of the application or termination of employment without notice at any time hereafter. I understand that, as part of the pre-employment process, an investigative consumer report may be obtained by the company, including information as to my character, general reputation, personal characteristics and mode of living. Upon my written request, within a reasonable time from the date of this application, additional information as to the nature and scope of the investigation and report, if any, will be provided. I hereby release all persons furnishing information in connection with the investigative consumer report from liability or damages incurred as a result of such an inquiry and furnishing of this information. I hereby authorize any and all schools, former employers, references, courts, and any others who have information about me to provide such information to the company and/or any of its representatives, agents, or vendors, and I release all parties involved from any and all liability for any and all damage that may result from providing such information. In consideration for employment by the company, if employed, I agree to conform to the rules, regulations, policies and procedures of the company at all times and understand that such obedience is a condition of employment. If employed, I understand that I retain my normal right to terminate any employment relationship at any time, with or without any notice or reason, and I understand that the company retains the same right. I also recognize that nothing shall alter or terminable-at-will nature of my employment relationship with the company unless it is in writing and signed by an owner of the company. I agree that in consideration of my employment with the company that if I file a lawsuit regarding the conditions of my employment or termination of employment, I will waive my right to a jury trial and that no demand, request or motion will be made for trial by jury. Instead, I agree that the case will be tried to a judge without a jury. By signing below, I acknowledge that I have read, understood and agree to the above statements. Applicant's Signature* Top
