Full Name *

Desired Division of Work *
Any DivisionAsphaltConcrete/HA5CorporateEquipmentMillingSite DevelopmentSoil Stabilization / FDR

Desired type of work *
CDL DriverCorporateEstimatorFinisherForemanLaborerOperatorProject ManagerTechnician

Desired hourly wage *

Skills *

Contact Information *
Email Address *

Phone Number *

Address 1*

Address 2

City *

State/Province *

Zip/Postal Code *

Are you legally able to work in the United States? *
YesNo

Are you 18 years of age or older? *
YesNo

Are you a military veteran? *
YesNo

If "Yes", dates of active duty:

Start Date:

End Date:

Have you worked for the company before? *
YesNo

If "Yes", write the start and end dates:

Start Date:

End Date:

Do you have your own transportation? *
YesNo

Do you have a valid Driver's License? *
YesNo

Driver's License Information
License number

License Class

License Expiration Date

Education
Select Highest Completed Education
GEDHigh SchoolSome CollegeCollege/University

School last attended

Employment History
Please provide accurate and complete information of your most recent full-time or part-time employment history.

1. Most Recent Employer

Company Name

Company Phone number

Date of Employment

Company Address

Supervisor Name

Rate of Pay

Job Title

Reason for Leaving

2. Employer

Company Name

Company Phone Number

Date of Employment

Company Address

Supervisor Name

Rate of Pay

Job Title

Reason for Leaving

3. Employer

Company Name

Company Phone Number

Date of Employment

Company Address

Supervisor Name

Rate of Pay

Job Title

Reason for Leaving

References: (Please provide professional references)

Reference Name

Relationship

Phone Number

Reference 2:

Reference Name

Relationship

Phone Number

PRIVACY STATEMENT
Personal information collected via this application will only be used for the purpose of recruitment by the company.

The information you submit to us may be disclosed to team members who are involved in the recruitment process.

Should you choose not to provide any of the information requested, we may be unable to fully process your application or properly consider you for employment.

Consent:

Full Name *

Signature *

Date *

DISCLAIMER*
Before signing this application, you should ask for assistance if you do not understand any statement, request for information, or need help in completing this application.

AT-WILL-EMPLOYMENT DISCLAIMER AND APPLICANTS AGREEMENT AND CERTIFICATION

•I hereby declare the information provided by me in this application for employment as true, correct, and complete to the best of my knowledge. I understand that if employed, any misstatement or omission of fact on this application may result in termination of my employment.
•I understand that the Company may contact all persons, schools, and employers, current or former, to verify my employment or obtain information that may be required to arrive at an employment decision. I hereby release the Company and the aforementioned who provide such information from any liability and damages regarding the provision of such information.
•I further acknowledge that my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the Company or myself. I understand that no representative of the Company, other than a Vice-President of the Company, has any authority to enter into any agreement for employment for any specified period of time or to make any agreement that contradicts or modifies the foregoing in any manner. Any written or oral statements to the contrary are hereby expressly disavowed and should not be relied upon by current or prospective employees.

I certify by my signature below that if employed by the Company, I will be available for out-of-town work at all times and for the duration of time necessitated by project conditions.

Disclaimer Acceptance *
I agree

DRUG-FREE WORKPLACE

The Company is a proud member of “Drugs Don’t Work in Georgia” and aims to provide a drug-free workplace for the safety of its employees and the general public. Involvement with illegal drugs by our employees is contrary to this objective.

• The illegal use, sale, distribution , or possession of any narcotic, drug or controlled substance, either on or off the job, will result in the immediate termination of employment.
• Every applicant who is considered for employment will be tested for the use of illegal drugs.
• Every employee remains subject, as a condition of continued employment, to additional drug testing, at various times to be selected by the Company.
• Failure to pass a drug screen test will preclude initial or continued employment with the Company.

AUTHORIZATION AND RELEASE FOR DRUG SCREEN TESTS
I hereby authorize Blount Construction Company, Inc. (along with any Physician, Clinic, Hospital or Laboratory designated by the Company to perform tests on me for the detection of illegal drugs. I give my permission to the designated Physician, Clinic, Hospital or Laboratory to release the results of such tests to the Company. I agree to release, forever discharge and hold harmless Blount Construction Company, Inc., including its successors, assigns, officers, directors, agents, and employee from any and all actions, cause of action, claims and demands, for any damage or loss which may be sustained by me, as a result of any employment action or separation from employment which may comply with the company’s anti-drug policy.

I agree

OTHER CONDITIONS OF EMPLOYMENT
Blount Construction Company, Inc. is proud to be an Equal Employment Opportunity and Affirmative Action Employer. We celebrate diversity and do not discriminate based on race, religion, color, national origin, sex, sexual orientation, age, veteran status, disability status, or any other applicable characteristics protected by law. All employment is decided on the basis of qualifications, merit, and business need.

Prospective Employee Self-Disclosure Survey (OPTIONAL)
This form is to be filled out by each prospective employee. Providing information is VOLUNTARY and is not required for employment. This form is for statistical purposes only and will not be used in determining employment eligibility. This information will be maintained separately from your application and will only be accessible by the Human Resources Department of Blount Construction Company, Inc.
I AcceptI Decline to submit information

Gender
MaleFemale

Ethnic Group/Race
African AmericanAmerican Indian or Alaska NativeAsianCaucasianHispanic or LatinoNative Hawaiian or Pacific IslanderOther

Veteran
NoYes