Preliminary Employment Application

Eagle Mountain Construction

This company is an equal opportunity employer and will not discriminate in the hiring process on the basis of sex, religion, race, color, age, national origin, ancestry or handicap.

General Information
Date:	Position Applying For:		Wage / Salary Desired:
Last Name:	First Name and Middle Intial:		Email:
Street Address:	Phone:		Emergency Phone:
City:	State:		Zip Code:
Are you 18 years of age or older? (yes or no)		Are you legally eligible for employment in the U.S.? (yes or no)
Have you been employed by EMC before? (yes or no)		Are you available for full time work? (yes or no)
Are you a U.S. Veteran? (yes or no)		Are you willing to travel? (yes or no)
Have you been convicted of a felony? (yes or no) If YES please explain:
Have you filed any workers compensation claims within the last 5 years? (yes or no) If YES please explain:
Do you have any physical, mental or medical impairment of disability that would limit your job performance for the position for which you are applying for? (yes or no) If YES please explain:
Education / Training
High School / Location:	Course of Study / Major:		Diploma:
College / Location:	Course of Study / Major:		Degree:
Trade School / Location:	Course of Study / Major:		Certification / Degree:
Any Specific Training?
Employment History
Company Name:	Contact Name / Supervisor:		Contact Phone Number:
Job Title / Role:	Work Dates From - To:		Wage / Salary:
Work Performed:
Company Name:	Contact Name / Supervisor:		Contact Phone Number:
Job Title / Role:	Work Dates From - To:		Wage / Salary:
Work Performed:
Company Name:	Contact Name / Supervisor:		Contact Phone Number:
Job Title / Role:	Work Dates From - To:		Wage / Salary:
Work Performed:
Enter Security Code:

Preliminary Employment Application

General Information

Education / Training

Employment History