APPLICATION FOR EMPLOYMENT
Equal Opportunity Employer
CONNOLLY CONSTRUCTION INC.
18409 N Cascade Rd.
Peosta, IA 52068
Phone: 563-876-3225
Fax: 563-876-3115
www.connollyconstructioninc.com
Please complete application in full
Personal Information
Last Name:
First Name:
Middle Initial:
Address:
City:
State:
Zip Code:
Phone:
Social Security#:
Referred By:
Email:
Are you at least 18 years or older? (If no, you may be required to provide authorization to work.)
Yes
No
Employment Desired
Position:
Date you can start:
Salary Desired:
Are you Employed?
Yes
No
If so, may we inquire of your present employer?
Yes
No
Have you ever applied to this company before?
Yes
No Date:
Education History
Education:
School Name/Location:
Years Attended:
Graduated?
Subject Studied:
Grammar School
High School
College
Trade or Business School
General Information
Subjects of special study/research work or special training/skills:
U.S. Military or Naval Service:
Rank:
Employment History
(Start with your most recent employment)
Company Name:
Employer Address:
Employer Phone:
Type of Business:
Supervisor Name:
Job Title:
Reason For Leaving:
Final Salary:
Start Date:
End Date:
Summary of job duties:
Company Name:
Employer Address:
Employer Phone:
Type of Business:
Supervisor Name:
Job Title:
Reason For Leaving:
Final Salary:
Start Date:
End Date:
Summary of job duties:
Company Name:
Employer Address:
Employer Phone:
Type of Business:
Supervisor Name:
Job Title:
Reason For Leaving:
Final Salary:
Start Date:
End Date:
Summary of job duties:
Company Name:
Employer Address:
Employer Phone:
Type of Business:
Supervisor Name:
Job Title:
Reason For Leaving:
Final Salary:
Start Date:
End Date:
Summary of job duties:
References
(Give below the names of three persons not related to you, whom you have known at least one year.)
Name:
Address:
Business/Occupation:
Phone:
Years Known:
I certify that the information I provided in this application is complete and accurate to the best of my knowledge. I understand that any misrepresentation or omission of facts in this application disqualifies me from further consideration, or if I am employed, is sufficient cause for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give Connolly Construction Inc. any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release Connolly Construction Inc. from all liability for any damage that may result from utilization of such information. I understand that if I am employed with Connolly Construction Inc., I will review the information contained in the employment packet including the Employee Handbook. I understand that any employment offer is contingent upon the following: (1) producing documents establishing my eligibility to work in the United States and (2) complying with Connolly Construction Inc. pre-employment application procedures.
By inputting my name below, I am electronically signing this form.