Employment Application

Employment Application

We Are Seeking Qualified People To Join Our Team

Interested in working at Phillips & Koch Construction? Please fill out the application below.





PERSONAL INFORMATION

First Name

Middle Initial

Last Name

Maiden Name

Email Address

Home Address

City

State

Zip Code

How long have you lived at your current address?

Home Phone #

Cell Phone #

Emergency #

Contact Name & Relationship

If you are under 18 years of age, state your age:

Can you prove your U.S. Citizenship?
YesNo

If NO, please provide your VISA Number and Expiration Date

List all of the positions you are applying for:

What is your desired salary?

How many hours can you work, Weekly?

Can you work nights? YesNo

Employment-Level desired?

Full-Time OnlyPart-Time OnlyFull or Part-Time

When are you available for work?

EDUCATION AND BACKGROUND INFORMATION

High School

Name

Complete Mailing Address

# of Years and Date Completed

Major/Degree

University / College

Name

Complete Mailing Address

# of Years and Date Completed

Major/Degree

Business / Trade School

Name

Complete Mailing Address

# of Years and Date Completed

Major/Degree

Professional School

Name

Complete Mailing Address

# of Years and Date Completed

Major/Degree

Have you ever been convicted of a crime?
YesNo

If YES, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

Have you ever been injured at work?
YesNo

If yes, explain how and when:

Do you have a DRIVER’S LICENSE? YesNo

Driver’s License Number:

State of Issue:

Expiration Date:

License Type:Operator   Commercial (CDL)   Chauffeur

What is your means of transportation to work?

Have you had any accidents during the past three years?
YesNo

If yes, please explain.

Have you had any moving violations during the past three years?
YesNo

If YES, please explain.

References

Please list two references other than relatives or previous employers.

Name

Company & Position

Address

Telephone #

Name

Company & Position

Address

Telephone #

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications and job skills for the specific position for which you are applying.

MILITARY

Have you ever served in the Armed Forces? YesNo

Discharge Date

Honorable Discharge?
YesNo

Specialty

Are you now a member of The National Guard? YesNo

Date Entered

Specialty

WORK EXPERIENCE

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name.

Employer #1

Employer Name

Address

Supervisor’s Name

Telephone #

Dates of Employment (from-to)

Pay / Salary

Your last Job Title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements, and/or promotions while you worked at this company.

Employer #2

Employer Name

Address

Supervisor’s Name

Telephone #

Dates of Employment (from-to)

Pay / Salary

Your last Job Title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements, and/or promotions while you worked at this company.

Employer #3

Employer Name

Address

Supervisor’s Name

Telephone #

Dates of Employment (from-to)

Pay / Salary

Your last Job Title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements, and/or promotions while you worked at this company.

Employer #4

Employer Name

Address

Supervisor’s Name

Telephone #

Dates of Employment (from-to)

Pay / Salary

Your last Job Title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements, and/or promotions while you worked at this company.

Employer #5

Employer Name

Address

Supervisor’s Name

Telephone #

Dates of Employment (from-to)

Pay / Salary

Your last Job Title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements, and/or promotions while you worked at this company.

May we contact your present employer? YesNo

QUALIFICATIONS

Are you a Journeyman? YesNo

Please list Certifications that you currently hold:

Expiration Date:

Expiration Date:

Expiration Date:

Expiration Date:

Expiration Date:

How much Experience do you have as a:

Millwright?

Years:

Months:

Welder?

Years:

Months:

Laborer?

Years:

Months:

Ironworker?

Years:

Months:

Who have you worked for in Construction?

Dates (from-to):

Dates (from-to):

Dates (from-to):

Dates (from-to):

Dates (from-to):

Please check the boxes of Computer Programs that you are proficient in:
Project
Microsoft Word
AutoCAD
EXCEL

MINIMUM TOOL LIST

Please check the boxes of the tools below that you currently have.
(*Minimum Laborers must have)

Hardhat- furnished by Phillips & Koch
Safety Glasses- furnished by Phillips & Koch
* Coveralls
* Boots- steel toes
* Gloves
* Tape Measure
* Email Address
* Phone with VoiceMail
Welding Hood
Cutting Goggles
Leathers for Welding
Slag Hammer
Framing Square
Pry Bar
Tri-Square
Tool Belt, Nail Apron, or Bolt Bags
Striker

Bevel Square
5 Locks & 5 Lock Out Tags
2' or 4' Levels
Flashlight
Punches
Pliers
* Crescent Wenches
Notepad and Pencil
Wrenches to 1 ¼"
Torpedo Level
Assorted Clamps
Sockets to 1 ¼"
(Hex) Allen Wrenches
Soapstone or Marker
Chalk Line
Vise Grips

JOB APPLICANT SKILL LEVEL SELF-EVALUATION FORM

Please mark your level of skill for each of the items below.

Project Management

ExcellentGoodFairPoor

Supervision Skills

ExcellentGoodFairPoor

Estimating

ExcellentGoodFairPoor

Carpentry

ExcellentGoodFairPoor

Concrete

ExcellentGoodFairPoor

Welding

ExcellentGoodFairPoor

Pipe Welding

ExcellentGoodFairPoor

Pipe Fitting

ExcellentGoodFairPoor

Cutting Torch

ExcellentGoodFairPoor

Millwright

ExcellentGoodFairPoor

Ironworker

ExcellentGoodFairPoor

Operator-Crane

ExcellentGoodFairPoor

Operator-Forklift

ExcellentGoodFairPoor

Operator-Man-lift

ExcellentGoodFairPoor

Reach Forklift

ExcellentGoodFairPoor

Precision Alignment

ExcellentGoodFairPoor

Laser – Level – Transit

ExcellentGoodFairPoor

Blueprint Reading

ExcellentGoodFairPoor

Punctuality

ExcellentGoodFairPoor

Attendance

ExcellentGoodFairPoor

Dependability

ExcellentGoodFairPoor

Productivity

ExcellentGoodFairPoor

Work Quality

ExcellentGoodFairPoor

Safety Training

ExcellentGoodFairPoor

Computer Skills

ExcellentGoodFairPoor

Communication Skills

ExcellentGoodFairPoor

Work Well With Others

ExcellentGoodFairPoor

SIGNATURE

By typing your name into the “Enter Electronic Signature” text field and clicking “Confirm Signature”, you are certifying that all information provided to Phillips & Koch Construction, Inc. is true and accurate.

Electronic Signature:
Confirm Signature: