Employment Application

Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the prescense of non-job-related medical condition or handicap.

Thorne’s Excavating Co. is an Equal Opportunity Employer

Date of application Position applied for Referral Source FriendRelativeWalk-InOther Referral Name Referral Contact Info / Phone Number Your Last Name Your First Name Your Middle Name Street Address City State Zip Code Telephone No. (with area code) email What is your date of birth? If you've been employed here before, date Are you prevented from lawfully becoming employed in this country because of Visa or immigration status? (Proof of citizenship or immigration status may be required upon employment) YesNo On what date would you be available for work? Can you travel if a job requires it? YesNo Have you been convicted of a crime within the last 7 years? (Conviction will not necessarily disqualify applicant from employment) YesNo If yes, please explain

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Employment Experience Employer 1 Employer 1 Name Dates Employed: Start Date Dates Employed: End Date Employer 1 Telephone Employer 1 Job Title Employer 1 Starting Hourly Rate/Salary Employer 1 Ending Hourly Rate/Salary Employer 1 Supervisor Employer 1 Work Performed Employer 1 Reason for leaving Employer 2 Employer 2 Name Dates Employed: Start Date Dates Employed: End Date Employer 2 Telephone Employer 2 Job Title Employer 2 Starting Hourly Rate/Salary Employer 2 Ending Hourly Rate/Salary Employer 2 Supervisor Employer 2 Work Performed Employer 2 Reason for leaving Summarize special skills and qualifications acquired from employment or other experiences

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Applicant Information Give names, and telephone numbers of three references who are not related to you and are not previous employers. Have you ever been injured on the job before? YesNo If yes, how? Have you ever received disability income payments or workman's compensation payments? YesNo Have you ever had injuries that may cause you not to be able to perform any duties that may be required with this job? Do you have a valid driver's license? YesNo Do you have a commercial driver's license (CDL)? Class AClass BClass C Have you had any speeding/traffic tickets, traffic accidents, or DUIs in the last 7 years? YesNo If yes, explain? Name of person and phone number to call in case of an emergency State any additional information you feel may be helpful to us in considering your application. Add resume

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Applicant's Statement I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not and is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given in my application or interviews is cause for immediate dismissal without compensation. I understand, also, that I am required to abide by all rules and regulations of Thorne's Excavating Company, LLC. I also authorize and agree to submit to drug or alcohol testing on employer's request. Refusal will result in immediate dismissal without compensation. Applicants agree to and will provide the following: - Pass a pre-employment drug screen - Provide two forms of Identification, one photo ID required - Complete E-Verification process - Provide bank account information for weekly direct deposits Type in your full name as signature of applicant (required) Today's Date Please leave this field empty.

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