Job Application 1 Applicant Information2 Applicant Skills3 Certification Applicant InformationApplicant Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Position Applied For*Are you at least 18 years old?*YesNoIf applicable, are you available to work overtime and weekends?*YesNoIf you are offered employment, when would you be available to begin work?Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Are you legally eligible for employment in the United States?*YesNoHave you ever been convicted of a felony*YesNoIf yes, please provide details (along with any future requirements)*Emergency ContactEmergency Contact Name* First Last Relationship to you*Phone* Applicant's SkillsForming ExperienceYears of experience*Ability*NoneLowMediumHighConcrete Finishing ExperienceYears of experience*Ability*NoneLowMediumHighDrive a Skid SteerYears of experience*Ability*NoneLowMediumHighDecorative Concrete ExperienceYears of experience*Ability*NoneLowMediumHighIf so, what?Applicant Employment HistoryList your current or most recent employment first.Employer Name*Supervisor Name* First Last Job Duties*Reason for Leaving*Dates of Employment (Month/Year)*Employer NameSupervisor Name First Last Job DutiesReason for LeavingDates of Employment (Month/Year)Employer NameSupervisor Name First Last Job DutiesReason for LeavingDates of Employment (Month/Year)ReferencesList any two people who would be willing to provide a reference for you.Name* First Last Phone*Relationship*Name* First Last Phone*Relationship* Certification I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination. I authorize Creative Concrete Solutions, LLC to contact former employers regarding my employment. I authorize my former employers to fully and freely communicate information regarding my previous employment (attendance, ability, attitude, etc). I authorize those persons designated as references to full and freely communicate information regarding my previous employment. I also authorize Creative Concrete Solutions, LLC to perform a background check. If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its President, the employment relationship will be “at-will.” In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the same right. Moreover, no agent, representative, or employee of Creative Concrete Solutions, LLC except in a specific written contract of employment signed on behalf of the organization by its President, has the power to alter or vary the voluntary nature of the employment relationship. I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.SignaturePrinted Name*Date Signed*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920NameThis field is for validation purposes and should be left unchanged.