Application For Employment KAMMINGA & ROODVOETS, INC. IS AN EQUAL OPPORTUNITY EMPLOYERPERSONAL INFORMATIONDate* Date Format: MM slash DD slash YYYY Name* First Last Phone*Email* Enter Email Confirm Email 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 Are you 18 years of age or older?*YesNoApplicants under the age of 18 will not be consideredAre you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?*YesNoProof of citizenship or immigration status will be required upon employmentAPPLICATION INFORMATIONJob LocationFloridaMichiganPosition(s) Applying For* Experienced Equipment Operator Experienced Pipelayer CDL A Truck Driver Experienced Construction Laborer Position(s) Applying For* Experienced Concrete Finishers General Laborers Experienced Excavator Operators Experienced Pipe Foreman Experienced Pipe Layer How Did You Learn About Us?* Job Posting Job Fair Relative Friend Other If other, please describeHave you ever been employed with us before?*YesNoIf yes, give dates*Are you currently employed?*YesNoDate available for work* Date Format: MM slash DD slash YYYY What is your desired wage range?Can you travel within the state if the job requires?*YesNoAre there any positions for which you should not be considered for or any essential job duties you cannot perform?*YesNoif yes, explain*Have you ever been convicted of a crime?*YesNoif yes, provide details of type of crime, date of conviction and penalty imposed*A conviction record will not necessarily be a bar to employment. This information will be used only for job related purposes and only to Have you ever been a member of the United States Military?*YesNoif yes, list branch, date of service and trainingHigh School (name, city, state)*Graduation date* Date Format: MM slash DD slash YYYY Post High School education or training?*YesNoif yes, list subject/training & any degree or certificate earnedWORK HISTORY(give information about previous 2 employers, starting with most recent)EmployerCity, StateDates employedJob title & dutiesManager's name & titleReason for leavingEnding wage/salaryEmployerCity, StateDates employedJob title & dutiesManager's name & titleReason for leavingEnding wage/salaryApplicants Statement - Kamminga & Roodvoets, Inc. is an equal opportunity employer. I have read and understand this statement.I certify that all such statements on this application are made truthfully and without evasion, and further understand and agree that such statements may be investigated and if found to be false will be sufficient reason for not being employed, or if employed, may result in my dismissal. I authorize the references listed in this application , and any prior employer, to give this Company any and all information, concerning my previous employment, and release all parties from all liability for any damage that may result from furnishing same to you. I hereby waive written notice that employment information is being provided by any person or organization. If I am hired, in consideration of my employment, I agree to abide by the rules and policies of this Company, including any changes made, and agree that my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either the Company or myself. I understand that no manager or other representative of the Company, other than the President, has any authority to enter into any agreements for employment for any specific or indefinite period of time, or to make any agreement contrary to the foregoing. Any such agreement made by the President must be in writing to be effective. If you are selected for hire, you will be offered employment provided you verify that you are authorized to work as required by the Immigration Reform and Contract Act of 1986.Digital SignatureDate Date Format: MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.