Job Application

Personal

Prospective employees will receive consideration without discrimination based on race, creed, color, sex, age; national origin, handicap, veteran status or any condition prescribed by state or local law.

Name(Required)

First Middle Last

Date of Birth(Required)

Date(Required)

Address(Required)

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

Home Phone

Cell Phone(Required)

Position Desired(Required)

Pay Expected(Required)

Apart from absence for religious observance, are you available for full time work?(Required)

Yes

If not, what hours can you work?

Will you work overtime if asked?(Required)

Yes

Would you be willing to work out of state?(Required)

Yes

When will you be available to begin work?(Required)

Do you have your own transportation?(Required)

Yes

Do you have a valid Alabama Drivers License?(Required)

Yes

If"Yes", do you have a CDL?

Yes

If"Yes", what class of CDL?

Class A

Class B

Class C

Other special training or skills ( language, machine operation, etc.)

Education

Graduate School

Name of Graduate School

Address of Graduate School

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

Graduate School - Course of Study

Graduate School - Number of Years Completed

Graduate School - Did you graduate?

Yes

Graduate School - Degree or Diploma

College

Name of College

Address of College

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

College - Course of Study

College - Number of Years Completed

College - Did you graduate?

Yes

College - Degree or Diploma

Business/Trade/Technical

Name of Business/Trade/Technical School

Address of Business/Trade/Technical

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

Business/Trade/Technical - Course of Study

Business/Trade/Technical - Number of Years Completed

Business/Trade/Technical - Did you graduate?

Yes

Business/Trade/Technical - Degree or Diploma

High School

Name of High School

Address of High School

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

High School - Course of Study

High School - Number of Years Completed

High School - Did you graduate?

Yes

High School - Degree or Diploma

Elementary School

Name of Elementary School

Address of Elementary School

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

Elementary School - Course of Study

First Last

Elementary School - Did you graduate?

Yes

Elementary School - Degree or Diploma

Employment 1

1 - Company Name

1 - Phone

1 - Address

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

1 - Employed From Date

1 - Employed To Date

1 - Name of Supervisor

First Last

1 - Weekly Pay Start

1 - Weekly Pay Last

1 - State Job Title and Describe Your Work

1 - Reason For Leaving

Employment 2

2 - Company Name

2 - Phone

2 - Address

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

2 - Employed From Date

2 - Employed To Date

2 - Name of Supervisor

First Last

2 - Weekly Pay Start

2 - Weekly Pay Last

2 - State Job Title and Describe Your Work

2 - Reason For Leaving

Employment 3

3 - Company Name

3 - Phone

3 - Address

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

3 - Employed From Date

3 - Employed To Date

3 - Name of Supervisor

First Last

3 - Weekly Pay Start

3 - Weekly Pay Last

3 - State Job Title and Describe Your Work

3 - Reason For Leaving

Employment 4

4 - Company Name

4 - Phone

4 - Address

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

4 - Employed From Date

4 - Employed To Date

4 - Name of Supervisor

First Last

4 - Weekly Pay Start

4 - Weekly Pay Last

4 - State Job Title and Describe Your Work

4 - Reason For Leaving

We may contact the employers listed above unless you indicate those you do not want us to contact.(Required)

Reason

Military

Did you serve in the U.S. Armed Forces?(Required)

If "Yes", in what Branch?

Describe any training received relevant to the position for which you are applying.

Additional Information

Membership in professional and civic organizations, special accomplishments, awards, etc.)

Emergency Contact

Emergency Contact Name(Required)

First Last

Emergency Contact Cell Phone(Required)

Emergency Contact Home Phone

Relationship to Emergency Contact(Required)

Applicant's Signature

The information I have provided in this Application for Employment is true, correct and complete. 'False, incomplete or misrepresented information of any kind, will be sufficient cause for my application to be rejected, or if discovered after I am employed, caustfor immediate termination of my employment I authorize Jerry Tidwell Construction, Inc to contact and obtain information about me from previous employers, educational institutions and "references" I provided, and any other party necessary to verify the accuracy of information I disclosed in this application, a related employment resume or a personal interview. To assist in the processing ofmy Application, I waive all rights and claims I may otherwise have against the employer or its representatives, fer seeking, and using information to evaluate my employment request and all other persona, corporations or organizations who . provide information for this purpose. This application will expire in 30 days. After that date, unless otherwise notified, I undertand that my status as an applicant will end. I may ro-apply for employment in the future by completing a new application. This application is not an employment agreement. If! accept an offer of employment I understand I may resign at any time, anddrry Tidwell Construction may terminate my employment at any time, with or without cause and without prior notice, unless required by law. I understand that no one, other than an executive officer of the employer, has authority to enter into any employment agreement with terms contrary to the foregoing and then only in writing signed by such officer.

Date Consent(Required)

56679