Employment Application Employment Application Step 1 of 5 20% 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 Cell Phone*Home/Other PhoneEmail* Date Available to Start* Date Format: MM slash DD slash YYYY Salary Requirements*If you are under 18 years of age, can you provide a work permit?*YesNoPlease explain*Have you ever worked for Prime Construction?*YesNoWhen did you work for Prime Construction?*Are you a citizen of the United States?*YesNoAre you legally allowed to work in the United States?*YesNoType of employment desired:* Full Time Part Time Temporary Seasonal Have you ever pleaded guilty, no contest or been convicted of a crime?*YesNoPlease provide dates and details*Please summarize your Special Skills or Qualifications* Employment HistoryMost Recent EmployerBeginning Date of Employment*Ending Date of Employment*Position(s) Held*Company Name*Company 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 Company Phone*Supervisor's Name* First Last Supervisor's Title*Your Responsibilities*Starting Salary and Title*Ending Salary and Title*Reason for Leaving*May we contact this employer for a reference?*YesNo Next Most Recent EmployerBeginning Date of Employment*Ending Date of Employment*Position(s) HeldCompany Name*Company 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 Company Phone*Supervisor's Name* First Last Supervisor's Title*Your Responsibilities*Starting Salary and Title*Ending Salary and Title*Reason for Leaving*May we contact this employer for a reference?*YesNo Next Most Recent EmployerBeginning Date of Employment*Ending Date of Employment*Position(s) HeldCompany Name*Company 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 Company Phone*Supervisor's Name* First Last Supervisor's Title*Your Responsibilities*Starting Salary and Title*Ending Salary and Title*Reason for Leaving*May we contact this employer for a reference?*YesNo Electronic SignatureI certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial and other related matters as may be necessary for employment decision. I hereby release employers, schools or individual from all liability when responding to inquiries in connection with my application. In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.Agreement*I agreeI do not agreeElectronic Signature*By checking the "I agree" box above and typing your name here, you are agreeing to your statements made in this electronic employment application.
