Last Name:
First:
Middle:
Street:
City:
State:
Zip Code:
County:
Home Phone Number:
Alternate Phone Number:
If Using PO Box, please indicate street address:
Work Availablility:
Are you at least 18 years of age:
Date Available to Start:
Are you willing to work any shift?:
If no, please explain:
Position Applying For:
Earnings Expected:
Who Referred You To Us?:
High School Name:
City/State:
Did you recieve:
Highest Grade Completed:
College or Technical School:
Name of college:
Address:
Years Attended (From mo/yr to mo/yr):
Major:
Minor:
GPA:
Degree:
Credit Hours:
Are you presently authorized to work in the United States on an unrestricted basis?:
Have you ever been convicted of a misdemeanor or felony?:
(If Yes, please describe conviction(s) and date(s)):
Military Status: Active Duty Dates (From mo/yr to mo/yr):
Branch of Service:
Duties:
Are you a member of a reserve organization?:

WORK EXPERIENCE: Please list each position held in order, from most recent/current to lease recent.

May we contact your current employer:
Explain any periods of unemployment:
Name of employer:
Nature of work:
Employer Address:
Phone:
Immediate Supervisor's Name:
Position Held:
Reason for Leaving:
Dates of Employment (mo/yr to mo/yr):
Final Compensation:
Name of employer:(1)
Nature of work:(1)
Employer Address:(1)
Phone:(1)
Immediate Supervisor's Name:(1)
Position Held:(1)
Reason for Leaving:(1)
Dates of Employment (mo/yr to mo/yr):(1)
Final Compensation:(1)
Name of employer:(2)
Nature of work:(2)
Employer Address:(2)
Phone:(2)
Immediate Supervisor's Name:(2)
Position Held:(2)
Reason for Leaving:(2)
Dates of Employment (mo/yr to mo/yr):(2)
Final Compensation:(2)

References: Please provide Three Business References

Business Reference 1 Name:
Business Reference 1 Address:
Business Reference 1 Phone:
Business Reference 2 Name:
Business Reference 2 Address:
Business Reference 2 Phone:
Business Reference 3 Name:
Business Reference 3 Address:
Business Reference 3 Phone:

Skills: Please list your competencies/skills and experience as they relate to the following categories:

Skilled Trades, Masonry, Heavy Equipment, CDL, etc.:
Maintenance:
Other:

PLEASE READ CAREFULLY

I certify that all the information given in this application has been carefully completed and is correct to the best of my knowledge and belief. I UNDERSTAND THAT MISREPRESENTATIONS OR OMISSIONS OF FACTS CALLED FOR HEREIN WILL BE SUFFICIENT CAUSE FOR CANCELLATION OF CONSIDERATION FOR ANY EMPLOYMENT OR OF ANY OFFER OF EMPLOYMENT OR FOR TERMINATION OF MY CONTINUED EMPLOYMENT WHENEVEER SUCH FACTS ARE DISCOVERED.

All job offers are contingent upon the applicant completing and passing a new hire drug screen, normally within the first 30 days of employment.

I authorize the investigation of any or all statements contained in this application  and also authorize any person, school, current employer (except as previously noted), past employers, credit bureaus, law enforcement agencies, government agencies and other organizations from any legal liability for furnishing such information and in making such statements. I understand that I have a right to request disclosure of the nature, scope and results of such inquiries.

Pursuant to the Immigration Reform and Control Act, I understand that I will be required, prior to hire, to present documentation to verify that I am a U.S. citizen or alien lawfully authorized to work in the United States.


I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT BY WESTERN OHIO CUT STONE DOES NOT CREATE THAT I HAVE BEEN A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR AN DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND HIRED AT THE WILL OF THE COMPANY AND THAT MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE.

I have read, understand and by my signature consent to these statements.

Signature:
Date: