Employment Application - Miller Builders

Date*

Name*

First

Last

Address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Phone*

Email*

Position Desired*

Additional experience/skills

Education

High School & Last Grade Completed

College & Years Completed

Course of Study

GPA

Other

Work History

Please list employment for the last 3 years. Start with your most recent employer.

Current or Last Employer

Date To:

Date From:

Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Phone

Duties & Responsibilities

Reason for leaving

Can we contact them for a reference?

Yes
No

Previous Employer

Date To:

Date From:

Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Phone

Duties & Responsibilities

Reason for leaving

Can we contact them for a reference?

Yes
No

Previous Employer

Date To:

Date From:

Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Phone

Duties & Responsibilities

Reason for leaving

Can we contact them for a reference?

Yes
No

Are you a Certified Worker?

Yes
No

Are you a Certified Commercial Driver?

Yes
No

Are you a Certified Crane Operator?

Yes
No

Please list any Special Skills

Have you ever been convicted of any offense other than a minor traffic violation?*

Yes
No

If yes, please provide information below:*

Have you received compensation for any job related injury?

Yes
No

If yes, please provide information below:

Please describe the nature of the injury, the employer when injured and date.

Declaration of Applicant

Consent*

I agree to the following:

I understand that if I am employed, any misrepresentation or omission of material facts on the application is
sufficient cause for dismissal. I understand that, if employed, my employment will be at-will so that it may be terminated by either me or Miller Builders at any time for any reason. Miller Builders in considering my application for employment may and will verify information set forth on this application. I authorize all persons, schools, companies, corporations, credit bureaus and law enforcement agencies to supply any information concerning my background. I understand that this application will remain active for 180 days. To be considered for employment after the expiration of the 180-day period, I must submit a new application.

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Phone

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