Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What position are you interested in? *

Estimator / Project Manager

Equipment Operator

Laborer

Pipelayer

Foreman

Mechanic

Union Affiliation *

Yes

No

Do you know anyone who has previously or is currently employed at R.L. Larson Inc? *

Yes

No

Can you travel is the job requires it? *

Yes

No

Are you prepared to work, overtime and stay overnight whenever and wherever we assign you? *

Yes

No

Are you prevented from becoming employed in the USA because of Visa or Immagration status? *

Yes

No

Available time to work *

Full Time

Part Time

Seasonal

Date available to work *

MM

DD

YYYY

PREVIOUS EMPLOYMENT

From

MM

DD

YYYY

To

MM

DD

YYYY

May we contact your previous supervisor for a reference?

Yes

No

From

MM

DD

YYYY

To

MM

DD

YYYY

May we contact your previous supervisor for a reference?

Yes

No

REFERENCES*

Phone

Country

(###)

###

####

Phone

Country

(###)

###

####

EDUCATION / TRAINING*

SCHOOL*

EMPLOYMENT POLICIES *

By checking the box directly below this paragraph, I understand RLLarson Excavating Inc. (RLL) is an equal employment opportunity employer and will not discriminate against any applicant or employee on any grounds protected under federal, state, or local law, including race, color, creed, religion, age, sex, sexual orientation, sexual harassment, national origin, ancestry, marital status, handicap, disability related to pregnancy or childbirth, membership or activity in any local commission, status regarding public assistance, membership/support or non-membership/non-support in any labor organization, or any other characteristic protected under federal, state or local law. None of the questions in this application are intended to elicit information regarding any protected characteristics, nor imply any limitation, illegal preferences, or discrimination based upon non-job-related information or protected characteristics. RLL complies with all applicable legal requirements in its hiring process and related tests and background checks. (It is not mandatory to fill out this form.)

Yes

AFFIRMITIVE ACTION SURVEY (VOLUNTARY)

The Purpose of this section is to assist in monitoring Affirmative Action Programs and to aid in complying with any required governmental record keeping or periodic reporting. This information is not part of your employment application, and will not be considered in the employment/selection process. If you choose to provide the information, please complete the following:

GENDER (CHOOSE ONE)

Male

Female

Other

RACE (CHECK ONE)

White

Black

Hispanic

American Indian / Alaskan Native

Native Hawaiian / Other Pacific Islanders

Asian

Other

VETERAN / U.S. MILITARY STATUS

Veteran

Non-Veteran

Active National Guard or Reservist

Do you claim disability status

Yes

No

DISABILITY STATUS, DEFINED AS

Has a physical, sensory or mental impairment (condition) which materially (significantly) limits one or more life activities

Has a record of such an impairment (condition)

Is regarded as having such an impairment (condition)

***INFORMATION ON THE (VOLUNTARY SECTION) WILL NOT BE IN YOUR PERSONAL FILE