Job Application

Personal Information

Full Name*

First Middle Last

Social Security Number

Phone Number

Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you 18 years or older?

Yes
No

Are you a U.S. Citizen?

Yes
No

Visa No. & Expiration

Position Applying For

Title*

Salary Desired

Referred By

Date Available

Education

High School

High School Address

High School Graduation Date

High School Subjects Studied

Post-Secondary Education

Post-Secondary Education Address

Post-Secondary Education Graduation Date

Post-Secondary Education Subjects Studied

Experience

Name and Phone Number of Employer 1

Dates of Employment with Employer 1

Position at Employer 1

Reason for Leaving Employer 1

Name and Phone Number of Employer 2

Dates of Employment with Employer 2

Position at Employer 2

Reason for Leaving Employer 2

Name and Phone Number of Employer 3

Dates of Employement with Employer 3

Position at Employer 3

Reason for Leaving Employer 3

References

Reference 1 Name*

Reference 1 Phone Number*

Your Relationship to Reference 1*

Years Acquainted with Reference 1*

Reference 2 Name

Reference 2 Phone Number

Your Relationship to Reference 2

Years Acquainted to Reference 2

Reference 3 Name

Reference 3 Phone Number

Years Acquainted to Reference 3

May we contact the employers & references listed on this application?

Yes
No

Why not?

Driving Record Information

Do you have a current, valid, and unrestricted driver's license?

Yes
No

License Class

State License Issued

Drivers License Number

Have you received DWI, DUI, or unsafe driving violations within the last two years?

Yes
No

Please list dates and type of violation

Have you been involved in any accident within the last 2 years?

Yes
No

Please list dates and type of accident

I authorize PKG Contracting, Inc. or its designated representative(s) to obtain and review information regarding my driving record in any state at any time while I am employed by (or seeking employment with) the company*

Yes

Type name to sign*

I certify, the facts contained in this application are true and complete to the best of my knowledge. I understand, if hired, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the the references listed above to give you any and all information concerning my previous employement,as well as, any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing this information to you. I understand and agree, that if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause. I understand that no promises regarding employment have been given to me about this job.*

Yes