Your Name:

Your Address:

City: State: AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code:

Telephone Number Where You Can Be Reached: 

Email Address:

What Position are you applying for?    Applying for Laborer position Applying for Safety Coordinator position Applying for Foreman / Operator position Applying for Operations Manager position

What Languages do you speak?      English      Spanish      German      French      Chinese      Vietnamese

Do you have a valid driver's license?     Yes      No   What Class?   "C"           CDL "A"          CDL "B"

Highest level of education:  High School Diploma      GED      Some College    Associate Degree 

                                              Bachelors Degree     Masters Degree   Trade School      Less than High School      Other

Have you done construction work before?  Yes    No           If Yes, how long? No Experience Less than One Year Construction Experience One to Three Years Construction Experience Three to Five Years Construction Experience Five to Ten Years Construction Experience Over Ten Years Construction Experience

Have you done utility work before?     Yes       No       If Yes, how long?    No Experience Less than One Year Utility Experience One to Three Years Utility Experience Three to Five Years Utility Experience Five to Ten Years Utility Experience Over Ten Years Utility Experience

Are you a United States Citizen?    Yes      No

If you are not a United States citizen, do you have legal documentation to work in the U.S. ?     Yes     No

Check each type of machinery you can operate:   Backhoe     Trackhoe     Boring Machine     Crane
                                                                                  Trenching Machine     Cherry Picker

Can you read blue prints?     Yes         No

Have you ever been in a management position in the construction industry?       Yes        No

If you answered yes to the above question, which best describes your position?    Experience as Operations Manager Experience as Foreman / Operator Experience as Safety Coordinator or Manager Experience as Crew Chief Experience as Other Management Position No Management Experience

Are you certified in a particular field or position?  Yes       No        What Area? 

Are you familiar with heavy equipment maintenance?    Yes       No

Are you knowledgeable with OSHA and state laws governing safety?    Yes     No

Are you familiar with Railroad Safety issues?      Yes       No

Have you ever done job estimating?      Yes       No

Are you familiar with locating and purchasing job materials?      Yes       No

Are you familiar with using a computer?    Yes       No

Are you willing to travel and work out of town?     Yes       No

Please provide any additional information or comments below.