APPLICATION FOR EMPLOYMENT 219 N Whiteside St. PO BOX 490 Hutchinson, KS 67504-0490 V: 620-665-1155 F: 620-665-0911 Step 1 of 5 20% Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone*Alternate PhoneEmail Do you have a valid driver's license?*Select OneYesNoDo you have any DUIs?*Select OneYesNoProvide date(s) of the DUI(s)*Do you have reliable transportation?*Select OneYesNoAre you at least 18 years of age?*Select OneYesNoAre you a citizen of the United States?*Select OneYesNoWhat languages to you speak fluently? English Spanish Other Select all that applyList other languages.*Are you willing to work out of town?*Select OneYesNoHave you been convicted of a felony?*Select OneYesNoPlease Explain.*Did you graduate from High School?*Select OneYesNoName of High School*Have you attended Vocational School?*Select OneYesNoName of Vocational School and Instructor(s).*Have you attended College?*Select OneYesNoName of School, years completed, degree.*Do you have any physical disabilty that would limit you on a construction site?*Select OneYesNoPlease, explain.* Construction experienceList how many years for all that apply.Concrete/MasonaryIron/MetalsCarpentryFinishesRate your skills4 being the bestFoundation WallsSelect One01234Steel ErectionSelect One01234Wood FramingSelect One01234Drywall & PaintSelect One01234Slab Prep/FinishingSelect One01234Metal BuildingsSelect One01234Metal FramingSelect One01234Doors & HardwareSelect One01234MasonrySelect One01234WeldingSelect One01234Trim WorkSelect One01234SpecialtiesSelect One01234Position desired* Laborer Carpentor Lead Carpentor Foreman Superintendent Intern Select all that applyWage desired /hour*Enter dollar and cent amount.Explain why this would be an appropriate position and wage for you.* This field is hidden when viewing the formEmployment History Employer Address Phone Reason for leaving May we contact? Supervisor Duties Start Date End Date Pay Start / End Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. As condition of employment, I agree to submit to:A medical examination?*Select OneYesNoA drug test?*Select OneYesNoA background check?*Select OneYesNoSTATEMENT OF RELEASE I understand that employment with Wiens & Company Construction, Inc. (the Company) is at-will, meaning that I or the Company may terminate my employment at any time, or for any reason consistent with applicable state or federal law. I authorize the Company to conduct an investigation of my employment and personal history to verify data submitted on this application and in any interviews. I authorize all individuals, institutions, schools, and firms named to provide any requested information and release them from any and all liability for providing the requested information. If I am offered employment I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by the Company and as permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to the Company the results of the examination, which results shall remain confidential. I understand that my employment or continued employment is contingent upon satisfactory medical examinations and drug tests, and if I am hired a condition of my employment will be that I abide by the Company's Drug and Alcohol Policy. I affirm that the information and statements I have provided herein are true, and complete to the best of my knowledge. I understand that if employed, any false statements on this application may result in termination.If you would like to attach a resume you may do so here.Accepted file types: doc, docx, pdf, odt, ott, Max. file size: 10 MB.Accepted resume formats are: Adobe Acrobat, Microsoft Word, and Open/Libre Office.Signature*Please type your full name, this will be your digital signature.EmailThis field is for validation purposes and should be left unchanged.
