Phillips & Koch ConstructionPhillips & Koch ConstructionPhillips & Koch Construction
(541) 485-0120
 
Eugene, Oregon 97402

Employment Application

We Are Seeking Qualified People To Join Our Team

Interested in working at Phillips & Koch Construction? Please fill out the application below. Required fields are marked in green.

    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?

    Phone #

    Emergency #

    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:

    Certification:

    Expiration Date:

    Certification:

    Expiration Date:

    Certification:

    Expiration Date:

    Certification:

    Expiration Date:

    Certification:

    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?

    Name:

    Dates (from-to):

    Name:

    Dates (from-to):

    Name:

    Dates (from-to):

    Name:

    Dates (from-to):

    Name:

    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 "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: