Name Social Security Number Telephone
Address City State Zip
Please List other Names Used Check If applicable
Under Age 18
Are you a U.S Citizen? Yes No
Are you an alien lawfully authorized to work in the United States? Yes No
(form I-90, INS verification must be completed by all new employees)

How Did You Hear About Shigley Construction?  Please check all that apply.
Unsolicited Private Placement Agency
(Please give name of agency.)
State Employment Office College Placement Service
(Please give name of School.)
Personal Contact (Please name)
 Reply to Advertisement
(Please give name and date of publication.)

Have You Ever Worked FOR Shigley Construction? Yes No    If yes, please answer the following:
Dates Worked Reason for Leaving

Do You Have Relatives Who Work For Shigley Construction?
Yes No   If yes, please list:

Have you ever been convicted of a crime in the last seven (7) years, or are you currently awaiting prosecution for any crime other than minor traffic violations? Yes No
(Your answer does not exclude you from further consideration: each situation is reviewed with regard to position applied for.)

EDUCATION / TRAINING - Relevant to the position which you are applying.
  School Name/Address Dates Graduated Major degree
From To
High School
College
Other
What position are you applying for?  
Are there any experiences, skills, or qualifications, which you feel would especially qualify you for work with Shigley Construction?

Do you hold any special license or certificates: Yes No Please Describe:

REFERENCES - List three references who are not related to you and are former employers
Name Address Phone Occupation # of years known
 1.
 2.
 3.

EMPLOYMENT HISTORY
  (Begin with the most recent or current employer and include U.S. military service if applicable.)
1. Employer Name and Address Dates Employed Job Title Supervisors Name Starting Pay Ending Pay
From To
Description of Job Responsibilities

Employers Telephone Reason For Leaving May We Contact
Yes No
 
2. Employer Name and Address Dates Employed Job Title Supervisors Name Starting Pay Ending Pay
From To
Description of Job Responsibilities

Employers Telephone Reason For Leaving May We Contact
Yes No
 
3. Employer Name and Address Dates Employed Job Title Supervisors Name Starting Pay Ending Pay
From To
Description of Job Responsibilities

Employers Telephone Reason For Leaving May We Contact
Yes No
 
4. Employer Name and Address Dates Employed Job Title Supervisors Name Starting Pay Ending Pay
From To
Description of Job Responsibilities

Employers Telephone Reason For Leaving May We Contact
Yes No
 
5. Employer Name and Address Dates Employed Job Title Supervisors Name Starting Pay Ending Pay
From To
Description of Job Responsibilities

Employers Telephone Reason For Leaving May We Contact
Yes No
 

EMERGENCY CONTACT (Please list an emergency contact person below.)
Name Address Telephone