Application Form

A-1 Advantage Asphalt, LLC. (the "Company") is an equal opportunity/affirmative action employer. All qualified applicants will be considered without regard to age, race, color, sex, religion, national origin, marital status, ancestry, citizenship, veteran status, sexual orientation or preference, or physical or mental disability.

Personal:

Name

Home Telephone

Cell Phone

Address

Position Applying For

Referral Source

Available Start Date

Have you ever been employed by A1 Advantage Asphalt?

If required for position, do you have a valid driver's license?

If yes, class

Are you 18 years or older?

If under 18, do you have a work permit?

Employment History:List all employments for the past 5 years, starting with the most recent position. All information must be completed. You may attach a resume, but not in place of completing the required information.

Indicate Prior Asphalt/Paving Experience

Present or Last Position

Employer

Supervisor Name

Supervisor Phone

Job Title

From:

Duties & Responsibilities

Present or Last Position

Employer

Supervisor Name

Supervisor Phone

Job Title

From:

Duties & Responsibilities

Present or Last Position

Employer

Supervisor Name

Supervisor Phone

Job Title

From:

Duties & Responsibilities

Education:

High School Name

Year Completed

Did You Graduate?

Degree(s) Received

College

Year Completed

Did You Graduate?

Degree(s) Received

Vocational, Business, Other ...

Year Completed

Did You Graduate?

Degree(s) Received

General

General:

May we contact your current employer for references?

If hired, will you be able to work overtime?

Will you be able to perform the essential job functions for the position you are applying for with or without reasonable accommodation?

Certification & AuthorizationThe above information is true and correct. I understand that, in the event of my employment by the Company, I shall be subject to dismissal if any information that I have given in this application is false or misleading or if I have failed to give any information herein requested, regardless of the time elapsed after discovery.

I authorize the Company to inquire into my educational, professional and past employment history references as needed to research my qualifications for this position. I hereby give my consent to any former employer to provide employment-related information about me to the Company and will hold the Company and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information. I further authorize the Company to obtain any credit and consumer check.

I understand that nothing in this employment application, the granting of an interview or my subsequent employment with the Company is intended to create an employment contract between myself and the Company under which my employment could be terminated only for cause. On the contrary I understand and agree that, if hired, my employment will be terminable at will and may be terminated by me or the Company at any time and for any reason. I understand that no person has any authority to enter into any agreement contrary to the foregoing.

If employed, I will be required to provide original documents verifying my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for completion of Form I-9.

I hereby acknowledge that I have read and agree to the above statements.

By checking this box, I authorize this document.

Name

Date

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Employment application

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