Application For Employment KAMMINGA & ROODVOETS, INC. IS AN EQUAL OPPORTUNITY EMPLOYERPERSONAL INFORMATIONDate* 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?* Yes No Applicants under the age of 18 will not be consideredAre you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?* Yes No Proof of citizenship or immigration status will be required upon employmentAPPLICATION INFORMATIONJob Location Florida Michigan Position(s) Applying For* Pipelayer Equipment Operator CDL A Construction Truck Driver Construction Laborer Position(s) Applying For* General Laborers Experienced Operators Concrete Finishers How Did You Learn About Us?* Job Posting Job Fair Relative Friend Other If other, please describe Referred by:* Have you ever applied with us before?* Yes No If yes, give dates* Are you currently employed?* Yes No Date available for work* MM slash DD slash YYYY What is your desired wage range? Can you travel within the state if the job requires?* Yes No Are there any positions for which you should not be considered for or any essential job duties you cannot perform?* Yes No if yes, explain* Have you ever been convicted of a crime?* Yes No if 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?* Yes No if yes, list branch, date of service and training High School (name, city, state)* Graduation date* MM slash DD slash YYYY Post High School education or training?* Yes No if yes, list subject/training & any degree or certificate earnedWORK HISTORY(give information about previous 2 employers, starting with most recent)Employer City, State Dates employed Job title & duties Manager's name & title Reason for leaving Ending wage/salary Employer City, State Dates employed Job title & duties Manager's name & title Reason for leaving Ending wage/salary Applicants 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 Signature Date MM slash DD slash YYYY CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.