Wisconsin Highway Construction Subcontractors

This application is to assist in determining the ability and qualifications of the applicant to perform the work he/she is seeking and is for informational purposes only. No offer of employment is made or intended in requesting an applicant to complete this form.

Position(s) Applied for: Date of Application:

Name:	First: Middle: Last:
Address:	Street: Apartment Number: City: Zip: State:
Phone:	Home Phone: Work Phone:

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status?	Yes	No
Are you currently a member of any union organization? If yes, what number?	Yes	No
Have you ever been employed with us before? If yes, when?	Yes	No
Do any of your friends or family work here? If yes, state name and relationship. Name: Relationship:	Yes	No
Do you have a valid driver's license? If yes, please provide the following: License Number: Class: Endorsements: Expiration Date: *Note: CDL is required for foreman, truck driver, and mechanic positions.	Yes	No
Do you have a hazardous waste training certificate?	Yes	No

Work Experience
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities, or other protected status.

Employer:	Dates Employed (month/year): to
Street:	City: State:
Phone:	Starting Job Title: Ending Job Title:
Supervisor:	Starting Salary: Ending Salary:
Work performed:
Reason for leaving:
May we contact your former employer?	Yes No

Employer:	Dates Employed (month/year): to
Street:	City: State:
Phone:	Starting Job Title: Ending Job Title:
Supervisor:	Starting Salary: Ending Salary:
Work performed:
Reason for leaving:
May we contact your former employer?	Yes No

Additional Information:

Please summarize special job-related skills and qualifications from employment or other experience.

Specialized Skills: (Skills, equipment operated, years of experience, etc.)

State any additional information you feel may be helpful to us in considering your application.

Applicant's Statement:

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer and that due to the seasonal nature of construction work, my employment would be temporary and layoffs may occur on short notice.

Signature: Date:

Confirmation Code:

COMPLETION OF THE INFORMATION BELOW IS OPTIONAL

Affirmative Action Voluntary Information - Completion of information below is voluntary.

We consider all applicants for positions without regard to race, creed, color, national origin, ancestry, age, sex, honesty or genetic testing, disability, arrest or conviction record, sexual orientation, marital status, military service membership, use of lawful products, pregnancy or childbirth, or other similarly protected status. We also comply with all applicable laws governing employment practices and do not discriminate on the basis of any unlawful criteria.

In an effort to comply with requirements regarding government record keeping, reporting and other legal obligations which may apply, we invite you to complete this applicant data survey. Providing this information is STRICTLY VOLUNTARY. Failure to provide will not subject you to any adverse personnel decision or action. Your cooperation is appreciated.

Please be advised that this survey is not a part of your official application for employment. It will not be used in any hiring decision. The information will be used and kept confidential in accordance with applicable laws and regulations.

Referral Source:

Walk-In

Employee

Government Employment Agency

Relative

Private Employment Agency

School

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Applicant Information:

Male

Female

Please check one of the following Equal Employment Opportunity Identification Groups:

White (not of Hispanic origin)

American Indian/Alaskan Native

Black (not of Hispanic origin)

Asian/Pacific

Hispanic

Veteran Status:

Disabled Veteran — A disabled veteran who is capable of performing a particular job with reasonable accommodations for his or her disabilities.

Other Protected Veteran — A veteran who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized. Please list service dates and military campaign(s).
to Military Campaigns:

Armed Forces Service Metal Veteran — A veteran who, while serving on active duty participated in a United States military operation for which an Armed Forces service medal was awarded. Please list service dates and military campaign(s). to Military Campaigns:

Veteran — Please list service dates: to

No military service.

EMPLOYMENT APPLICATION

Employment Opportunities