Job Application - Apply To Bothar Construction

Name*

First Last

Address*

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

Phone*

Date*

Are you 18 years or older?*

Yes
No

Are you prevented from lawfully becoming employed in this country because of Visa or immigration status?*

Yes
No

Employment Desired

Salary Desired

Date you can start

Are you employed now?

Yes
No

If so may we inquire of your present employer

Yes
No

Are you willing to travel?

Yes
No

Outside of NY

Yes
No

Are you currently on lay-off status and subject to recall?

Yes
No

Ever applied to this company before?

Yes
No

When?

Referred By

Education

Select all that applies

Grammar School
High School
College
Trade, Business or Correspondence School

Grammar School

Name of School

Address

Street Address City State / Province / Region ZIP / Postal Code

Number of years attended

Subjects studied

Did you graduate?

Yes
No

High School

Name of School

Address

Street Address City State / Province / Region ZIP / Postal Code

Number of years attended

Subjects studied

Did you graduate?

Yes
No

College

Name of School

Address

Street Address City State / Province / Region ZIP / Postal Code

Number of years attended

Subjects studied

Did you graduate?

Yes
No

Trade, Business or Correspondence School

Name of School

Address

Street Address City State / Province / Region ZIP / Postal Code

Number of years attended

Subjects studied

Did you graduate?

Yes
No

Special Skills/Certifications

Have you ever taken an OSHA 10 or 30 Hour Safety Course

Yes
No

If yes can you provide documentation

Yes
No

Former Employers

(list below last 4 employers, starting with the most recent)

Start/End date	Name & Address	Salary	Postilion	Reason for Leaving

Driving & Accident Information

(I understand that if this position requires a valid driver's license, proof will be required after hire)

Drivers Licenses Class (A,B,D)

State of License

Endorsements

Driving Experience. (Select those which apply)

Dump Truck Type

Dump Truck Date Operated

Dump Trailer Type

Dump Trailer Date Operated

Semi-Tractor Type

Semi-Tractor Date Operated

Tractor Trailer Type

Tractor Trailer Date Operated

Other Type

Other Date Operated

Equipment Experience (Select those which apply)

Excavator Type

Excavator Date Operated

Backhoe Type

Backhoe Date Operated

Forklift Type

Forklift Date Operated

Trencher Type

Trencher Date Operated

Paver Type

Paver Date Operated

Screed Type

Screed Date Operated

Skid steer Type

Skid steer Date Operated

Milling Machine Type

Milling Machine Date Operated

Dozer Type

Dozer Date Operated

Crane Type

Crane Date Operated

Other Type

Other Date Operated

Specialized Skills (Select those which apply)

Confined Space Training
Hazmat Training
First Aid/CPR
OSHA
Drug & Alcohol Training
Other

Other

References

(Give the names of three persons not related to you, whom you have known at least one year)

Three References

Name	Address	Business	Years Acquainted

NOTE TO APPLICANT*

BOTHAR Construction, LLC performs highway and road construction which requires strenuous activities including heavy lifting, long hours and difficult weather conditions. If you are not in good physical shape or have difficulties performing physical labor you may not wish to work at BOTHAR Construction, LLC. By completing this application you are acknowledging these conditions and are aware of the risks associated with this type of work if not performed properly.

CERTIFICATION AND RELEASE

“I certify that the information in this application is true and understand that misrepresentations or false or omitted facts may result in my termination, regardless of the time of discovery by the company. I also understand that, if hired, my employment is for no definite period and may be terminated at any time without written notice and that, absent a written contract signed by the Members of the company, I will remain an at-will employee and can be terminated at any time without any notice. I authorize investigation of the statements contained herein and the references listed above to give you any and all information concerning my pervious employment and any pertinent information such references may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.”

First Last

Date*

BOTHAR Construction, LLC

ADDITIONAL APPLICANT DATA Applicants are considered for all positions, and employees are treated during employment without regard to age, race, creed, color, national origin, sexual orientation, military status, sex, disability, predisposing genetic characteristics, marital status, pregnancy, domestic violence victim status, or any other basis prohibited by local, state or federal law to refuse to hire or employ or to bar or to discharge from employment such individual or to discriminate against such individual in compensation or in terms, conditions or privileges of employment. Government agencies at times require periodic reports on the sex, ethnicity, disability, veteran and other protected status of applicants. This data is for analysis and possible affirmative action only. Solely to help us comply with government record keeping, reporting and other legal requirements, we request that you also fill out the tear-off sheet. This data is for periodic government reporting and will be kept in a confidential file separate from your Application for Employment.

Name

First Last

Position Applied For

Phone

Date

Address

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

Referral Source

Check one

Male
Female

Check one