Employment Application First Name: Last Name: Address: City: State: Zip: Desired Position: Desired Salary: Date you can start: Email: Phone: Emergency Contact: Relationship: Are you eligible to work in the U.S.?(Proof of identity and eligibility will be required upon employment) YESNO Can you perform essential functions of the position for which you are applying, with or without a reasonable accommodation? YESNO Have you ever been terminated from employment or asked to resign by an employer? YESNO If yes, please provide company name and details: Have you ever been denied a license, permit, or privilege to operate a motor vehicle? YESNO If yes, please explain: Has any license, permit or privilege ever been suspended or revoked? YESNO If yes, please explain: Have you ever been convicted of a felony? YESNO If yes, please explain: Attendance / Reliability Do you have responsibilities other than work that will interfere with specific job requirements such as, traveling? YESNO If yes, please explain: Education High School Name and Location: No. of yrs. Attended: Received Diploma: YESNO College / University Name and Location: No. of yrs. Attended: Degree Received: Subjects Studied/Major: Trade, Business or Correspondence School Name and Location: No. of yrs. Attended: Degree Received: Subjects Studied/Major: Employment Record PREVIOUS EMPLOYER: Address: City: State: Zip: Phone: Fax: Position held: From: To: Salary: Reason for leaving: ANY GAPS IN EMPLOYMENT AND OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MONTH/YEAR) AND REASON 2nd PREVIOUS EMPLOYER: Address: City: State: Zip: Phone: Fax: Position held: From: To: Salary: Reason for leaving: ANY GAPS IN EMPLOYMENT AND OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MONTH/YEAR) AND REASON 3rd PREVIOUS EMPLOYER: Address: City: State: Zip: Phone: Fax: Position held: From: To: Salary: Reason for leaving: ANY GAPS IN EMPLOYMENT AND OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MONTH/YEAR) AND REASON Personal References:(Must have at least two professional contacts) Name: Relationship Phone/Email: Email: Company: Years Acquainted: Name: Relationship Phone/Email: Email: Company: Years Acquainted: Name: Relationship Phone/Email: Email: Company: Years Acquainted: Resume Please attached your resume (PDF, MSWord) Please read carefully before submitting this form: Fletco Construction is an equal opportunity employer. Fletco Construction does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status, or unfavorable discharge from military service.I authorize Fletco Construction to contact references provided as it may be necessary in arriving at an employment decision. In the event of employment, I understand that false or misleading information given in my application or interview may result in termination. Additionally, I understand that I am required to abide by all rules and regulations of the company. I understand that information I provide regarding current and or/previous employers may be used, and those employers will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to: Review information provided by current/previous employers Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and Have a rebuttal statement attached to the alleged erroneous information if the previous employers(s) and I cannot agree on the accuracy of the information. I understand that nothing in this application, or in any prior or subsequent written or oral statement, creates a contract of employment or any rights of this contract. I agree and understand that if I am hired by Fletco Construction my employment will be “At- Will”, for an indefinite period, and may be terminated at any time with or without cause or notice. I understand that I have the right to end my employment at any time. I also understand that no one has the authority to enter any contract, agreement, or modification of the foregoing unless such contract, agreement or modification is in writing and signed by a chief of Fletco Construction. I certify that I do not have any detectable amounts of prohibited substances in my system at the time of taking my pre-employment drug screen. I understand that if my drug screen turns out positive for a prohibited substance, I will not be eligible for hire, or if I am hired pending the outcome of such a test, I will be subject to immediate termination.