Employment Application

Date*

MM slash DD slash YYYY
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:

MM slash DD slash YYYY
Date From:

MM slash DD slash YYYY
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:

MM slash DD slash YYYY
Date From:

MM slash DD slash YYYY
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:

MM slash DD slash YYYY
Date From:

MM slash DD slash YYYY
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
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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Employment Application

Education

Work History

Declaration of Applicant