Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.S.R. Weidema Application for EmploymentWe consider applicants for all positions without regard to race, color, creed, religion, national origin, sex, sexual orientation, disability, age, marital status, familial status, membership or activity in a local human rights commission, or status with regard to public assistance, or any other legally protected status. Equal Opportunity Employer “Drug Free Workplace”Date of Application *Position(s) Applied For:How Did you Learn About Us?AdvertisementEmployment AgencyFriendRelativeInquiryOtherOther – How Did You Learn About Us? *How Did You Learn About Us?Name *FirstMiddleLastAddress *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Are you currently employed? *YesNoMay we contact your present employer? *YesNoAre you currently on “lay-off” status and subject to recall? *YesNoAre you a member of a Union? *YesNoUnion *If Yes, Please enter Union NameHave you ever filed an application with us before? *YesNoPrevious Application Date *If Yes, Please Enter Date of Previous ApplicationHave you ever been employed with us before? *YesNoEmployed with Us *If Yes, Please list Previous Employment Date(s)Do any of your friends or relatives, other than your spouse, work here? *YesNoFriends/Relatives/Spouse Work Here *If Yes, Please list Name, Relationship, LocationCan you travel if a job requires it? *YesNoAre you available to work? *Full TimePart TimeTemporaryOtherDate Available for WorkWhat is your desired salary range?Are 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 employment.EducationHigh School Name and Address *High School Diploma *YesNoEquivalentUndergraduate College Name and AddressUndergraduate College Years Completed1234+Years CompletedCollege Course of StudyUndergraduate College Diploma/DegreeYesNoDiploma/DegreeGraduate/ Professional College Name and AddressGraduate/ Professional Years Completed1234+Years CompletedGraduate/ Professional Course of StudyGraduate/ Professional Diploma/DegreeYesNoDiploma/DegreeOther Education – Please SpecifyWork ExperienceStart with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.1. Employer NamePrevious Employer 1 AddressEmployer AddressPrevious Employer 1 Starting/Present Job TitlePlease list Starting and Present Job TitlePrevious Employer 1 Reason for LeavingPlease Describe Reason for LeavingPrevious Employer 1 SupervisorSupervisorPrevious Employer 1 TelephoneEmployer Telephone Number(s)Previous Employer 1 Starting DateStarting DatePrevious Employer 1 Ending DateEnding DatePrevious Employer 1 ContactYesNoMay We Contact?Previous Employer 1 Work PerformedPlease Describe Work Performed2. Employer NamePrevious Employer 2 AddressEmployer AddressPrevious Employer 2 Starting/Present Job TitlePlease list Starting and Present Job TitlePrevious Employer 2 Reason for LeavingPlease Describe Reason for LeavingPrevious Employer 2 SupervisorSupervisorPrevious Employer 2 TelephoneTelephone Number(s)Previous Employer 2 Starting DateStarting DatePrevious Employer 2 Ending DateEnding DatePrevious Employer 2 ContactYesNoMay We Contact?Previous Employer 2 Work PerformedPlease Describe Work Performed3. Employer NamePrevious Employer 3 AddressEmployer AddressPrevious Employer 3 Starting/Present Job TitlePlease list Starting and Present Job TitlePrevious Employer 3 Reason for LeavingPlease Describe Reason for LeavingPrevious Employer 3 SupervisorSupervisorPrevious Employer 3 TelephoneTelephone Number(s)Previous Employer 3 Starting DateStarting DatePrevious Employer 3 Ending DateEnding DatePrevious Employer 3 ContactYesNoMay We Contact?Previous Employer 3 Work PerformedPlease Describe Work Performed4. Employer NamePrevious Employer 4 AddressEmployer AddressPrevious Employer 4 Starting/Present Job TitlePlease list Starting and Present Job TitlePrevious Employer 4 Reason for LeavingPlease Describe Reason for LeavingPrevious Employer 4 SupervisorSupervisorPrevious Employer 4 TelephoneTelephone Number(s)Previous Employer 4 Starting DateStarting DatePrevious Employer 4 Ending DateEnding DatePrevious Employer 4 ContactYesNoMay We Contact?Previous Employer 4 Work PerformedPlease Describe Work PerformedComments:Include explanation of any gaps in employment.Describe any specialized training, apprenticeship, professional, trade and business activities:You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected statusDescribe any job-related training received in the United States military:Please Enter Years of Experience at the following Crafts:Sewer/WaterYearsSuperintendentYearsFront End LoaderYearsTruck DriverYearsProject ManagerYearsUnionYearsForemanYearsDozerYearsLowboyYearsProject EngineerYearsTop ManYearsPipe LayerYearsSkid SteerYearsHeavy MechanicYearsEstimatorYearsBottom ManYearsExcavatorYearsMotor GraderYearsWelderYearsOtherHave you worked with Trench Shields/Boxes?YesNoCan you accurately set up lasers?YesNoCan you read plans accurately?YesNoDo you have the required license(s) for the position you are applying for?YesNoTrench ExperienceYears of ExperienceLaser ExperienceYears of ExperiencePlans Experience (copy)Years of ExperienceDrivers LicenseType of Driver’s License and applicable EndorsementsList any additional information or qualifications that you feel may be helpful to us in considering your application.Personal/Professional ReferencesDo not include family members or past supervisors.Reference 1Name and OccupationReference 1 PhoneTelephone NumberReference 1 Best Time to CallBest Time to CallReference 2Name and OccupationReference 2 PhoneTelephone NumberReference 2 Best Time to CallBest Time to CallReference 3Name and OccupationReference 3 PhoneTelephone NumberReference 3 Best Time to CallBest Time to CallApplicant's StatementI certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. 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 employer. Minorities and females are encouraged to apply. We use E-Verify to validate your ability to work legally in the United States. Equal Opportunity Employer – “Drug Free Workplace”Signature Clear Signature S.R. Weidema – Voluntary Affirmative Action FormEmployees are treated during the hiring process and employment without regard to race, color, creed, religion, national origin, sex, sexual orientation, disability, age, marital status, familial status, membership or activity in a local human rights commission, or status with regard to public assistance. As an employer with an Affirmative Action Program, we comply with government regulations, including Affirmative Action responsibilities where they apply. The purpose for this Data Record is to comply with government record keeping, reporting and other legal requirements. Periodic reports are made to the government on the following information. The completion of this Data Record is optional. If you choose to volunteer the requested information please note that all Data Records are kept in a Confidential File and are not a part of your Application for Employment or personnel file. Please note: YOUR COOPERATION IS VOLUNTARY. Inclusion or exclusion of any data will not affect any employment decision.Position(s) Applied For:Ethnic OriginWhite, Not of Hispanic OriginBlack, Not of Hispanic OriginHispanicAsian or Pacific IslanderAmerican Indian/Alaskan NativeOtherGenderMaleFemaleAre you a Vietnam-era veteran who served on active duty for more than 180 days during the Vietnam-era?YesNoAre you a disabled veteran?YesNoOther Qualifying Veteran:Please list Qualification and DatesDo you have a disability or any physical condition which may limit your ability to perform the position for which you have applied?YesNoDo you request that S.R. Weidema, Inc., consider any special arrangements to accommodate this condition?YesNoSpecial ArrangementsIf yes, please describe the job-related functional limitations that result from the impairment and any special accommodation or method or procedures, which would allow you to perform the duties of the position for which you are otherwise qualified.AFFIRMATIVE ACTION FORM – NameNameAFFIRMATIVE ACTION FORM – DateDateSignature Clear Signature Submit