Your Details

Applicant Name *

First Name *

Last Name *

Address* *

City *

State *

Postal code *

Phone *

Email *

Position Details

Position Applying For *

Are you at least 18 years old? *

Yes

If applicable, are you available to work overtime and weekends? *

Yes

If you are offered employment, when would you be available to begin work? *

Are you legally eligible for employment in the United States? *

Yes

Have you ever been convicted of a felony? *

Yes

If yes, please provide details (along with any future requirement)

Emergency Contact

Emergency Contact Name*

First Name *

Last Name *

Phone *

Relationship to you *

Applicant's Skills

Forming Experience

Years of experience *

Ability *

Concrete Finishing Experience

Years of experience *

Concrete Finishing Ability *

Drive A Skid Steer

Years of experience *

Ability *

Decorative Concrete Experience

Years of experience *

Ability *

If so, what?

Applicant Employment History

List your current or most recent employment first.

Employer Name *

Supervisor Name

First *

Last *

Job Duties *

Reason for Leaving *

Dates of Employment (Month/Year - Month/Year) *

2nd Most Recent Employer

Employer Name

Supervisor Name

First

Last

Job Duties

Reason For Leaving

Dates of Employment (Month/Year - Month/Year)

3rd Most Recent Employer

Employer Name

Supervisor Name

First

Last

Job Duties

Reason for Leaving

Dates of Employment (Month/Year - Month/Year)

References

List any two people who would be willing to provide a reference for you.

Reference 1: Name *

First *

Last *

Phone *

Relationship *

Reference 2: Name *

First *

Last *

Phone *

Relationship *

Certification

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize Creative Concrete Solutions, LLC to contact former employers regarding my employment. I authorize my former employers to fully and freely communicate information regarding my previous employment (attendance, ability, attitude, etc). I authorize those persons designated as references to full and freely communicate information regarding my previous employment. I also authorize Creative Concrete Solutions, LLC to perform a background check.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its President, the employment relationship will be “at-will.” In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the same right. Moreover, no agent, representative, or employee of Creative Concrete Solutions, LLC except in a specific written contract of employment signed on behalf of the organization by its President, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

Printed Name *

Date Signed *