Application – Great Plains Construction, LLC

First Name

Middle

Last

Address

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

Phone

Email

In Case Of Emergency Please Notify

Name

First Last

Relationship To You

Address

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

Phone

Position Seeking

Choose All That Apply -

Full-Time
Part-Time
Operator
Roustabout
Office

Pay Expected:

Date Available:

DATA

If you are hired you will be required by federal law to complete an I-9 Form and furnish proof of your identity and right to work.

Are you at least 18 years old?

Yes
No

If not, do you have a valid work permit?

Yes
No

Are you either a US citizen or an alien who is lawfully authorized to work in the US?

Yes
No

Check all days you are available for work:

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Check all hours you are available for work:

7AM-3PM
3PM-11PM
11PM-7AM

Have you previously applied for employment with this facility?

Yes
No

If so, when and where were you offered a position?

Do you have reliable means of transportation to get to work?

Yes
No

Is there any reason why you cannot arrive to work on time and remain at work through each scheduled workday?

Yes
No

If yes, explain:

How many days were you absent from work during the last 24 months?

Provide reasons for your absences:

Do you have any physical or mental conditions, which may limit your ability to perform the job for which you are applying?

Yes
No

If yes, describe such conditions and specify work limitations:

Profession

State License and Expiration

City License and Expiration

If you are a professional, have a profesional group, organization, licensure board, etc. ever disciplined you?

Yes
No

List commercial projects, by type, that you have been involved with or worked on (Such as: schools, office buildings, high-rises, etc.)

List industrial projects, by type, that you have been involved with or worked on (Such as: mfg., water treatment, power plants, etc.)

Would you consider your experience and strength to be primarily in (Check all that apply)

Commercial
Industrial
Residential
Petroleum
Manufacturing
Other

What Equipment Do You Have Experience With?

Dozer
Grader
Backhoe
Mini-Ex
Skidsteer
Other

If Other, please explain -

Education

Name of School

Address of School

Diploma

Yes
No

Certificate

Yes
No

Major Area Of Study

Number of Years

Last Year

Name of School

Address of School

Diploma

Yes
No

Certificate

Yes
No

Major Area Of Study

Number of Years

Last Year

Name of School

Address of School

Diploma

Yes
No

Certificate

Yes
No

Major Area Of Study

Number of Years

Last Year

Personal References

Name

Address

Telephone (with area code)

Relationship

Name

Address

Telephone (with area code)

Relationship

Name

Address

Telephone (with area code)

Relationship

Name

Address

Telephone (with area code)

Relationship

Employment

Have you ever been discharged or asked to resign from a position?

Yes
No

Please use this space to provide a detailed explanation of all prior disciplinary problems/actions:

May we contact your present employer?

Yes
No

If no, explain:

May we contact your previous employers?

Yes
No

If no, explain:

Employer Name

Address

Telephone (with area code)

Occupation

Supervisor Name

Dates Of Employment

Employer Name

Address

Telephone (with area code)

Occupation

Supervisor Name

Dates Of Employment

Employer Name

Address

Telephone (with area code)

Occupation

Supervisor Name

Dates Of Employment

Employer Name

Address

Telephone (with area code)

Occupation

Supervisor Name

Dates Of Employment

Miscellaneous

Have you ever been convicted of a crime other than a traffic offense?

Yes
No

If yes, explain:

Please feel free to add any special skills, experience or other information that related to your qualifications for the job you are applying for:

Enter the letters/numbers below

Applicant's Statement*

Please enter your name above if you agree with the below statement -

THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND I HAVE NOT WITHHELD ANY FACT OF CIRCUMSTANCE THAT COULD, IF DISCLOSED, AFFECT MY APPLICATION UNFAVORABLY. I UNDERSTAND THAT ANY FALSE OR MISLEADING STATEMENT OR ANY MATERIAL OMISSION IN THIS APPLICATION OR IN MY PHYSICAL EXAMINATION WILL BE GROUNDS FOR REJECTION OF MY APPLICATION OR (IF I HAVE BEEN HIRED) FOR MY IMMEDIATE DISMISSAL.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION, INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT, AND ANY OTHER INFORMATION, PERSONAL OR OTHERWISE. I UNDERSTAND THAT I HAVE THE RIGHT TO MAKE A WRITTEN REQUEST WITHIN A REASONABLE PERIOD OF TIME TO RECEIVE ADDITIONAL INFORMATION ABOUT THE NATURE AND SCOPE OF ANY SUCH INVESTIGATIVE REPORT THAT IS MADE. I RELEASE ALL PARTIES FROM LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING INFORMATION AND OPINIONS TO THE COMPANY. I RELEASE AND INDEMNITY THE COMPANY AGAINST ANY LIABILITY THAT MAY RESULT FROM MAKING SUCH AN INVESTIGATION.

IF HIRED, I CONSENT TO TAKING PHYSICAL EXAMINATIONS AND TESTS REQUIRED BY THE COMPANY. I CONFIRM THAT NO PROMISE REGARDING EMPLOYMENT (OR THE TERMS AND BENEFITS THEREON) HAS BEEN MADE TO ME AND I UNDERSTAND THAT NO SUCH PROMISE OR COMMITMENT WILL BE BINDING UPON THE COMPANY UNLESS IT IS MADE IN WRITING AND SIGNED BY THE ADMINISTRATOR OF COMPANY. IF AN EMPLOYMENT RELATIONSHIP IS ESTABLISHED, I UNDERSTAND THAT I HAVE THE RIGHT TO TERMINATE MY EMPLOYMENT AT ANY TIME AND THAT THE COMPANY RETAINS A SIMILAR RIGHT.

Great Plains Contstruction, LLC

GPC

APPLY NOW

In Case Of Emergency Please Notify

Position Seeking

DATA

Profession

Education

Personal References

Employment

Miscellaneous