Prillaman's Crane & Rigging
Employment Application
Name: *
Last, First, MI
Street Address: *
City, State, Zip
Phone Number | Email: *
Date Available: *
D.O.B | SSN: *
Position Applying For: *
Are you a citizen of the United States:
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Are you authorized to work in the United States: *
Have you ever worked for Prillaman's Crane: *
No or Yes | If Yes, please explain
Have you ever been convicted of a felony? *
No or Yes | If Yes, please explain
TO BE READ AND SIGNED BY APPLICANT I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company. I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to: *Review information provided by previous employers; *Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and *Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information. *
Please enter your name & date of signature (Your Digital Signature & Date serves as Authorization)
Accident Record: *
Please explain- Date | Nature of Accident | Injuries/ Fatalities
Traffic Convictions & Forfeitures For The Past 3 Years: *
Other than parking violations- Date | Location | Charge | Result
List all Drivers License | Permits | Certifications *
State | License Number | Type | Expiration Date
Have you ever been denied a License, Permit, or Privilege to Operate a Vehicle? *
No or Yes | If Yes, please explain
List courses & training other than shown elsewhere in the application:
Please explain (Include States & Dates)
Education: *
High School Dates | College Dates/ Degrees | Other Dates/ Degrees
References: *
Please list 3 professional references & phone Number
Previous Employment: *
Company | Dates | Position | Reason for Leaving | Salary
May we contact you previous employers? *
Military Service:
Branch | Dates | Rank at Discharge | Type of Discharge (Please explain if other than honorable)
Please Enter Digital Signature and Date of Disclaimer: *
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
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Subject Line: Employment Application- (Name)
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