Employee Job Application – Murphy Clearing & Grading Inc.

Name(Required)

First Middle Last

Birthdate(Required)

Social Security #(Required)

Phone(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Driver’s License No(Required)

Upload Driver’s License(Required)

Drop files here or

Max. file size: 100 MB.

State(Required)

Is your license currently suspended or revoked?(Required)

Yes

No

If so, state reason:(Required)

Have you been convicted of a felony?(Required)

Yes

No

If yes, explain(Required)

Are you currently on probation?(Required)

Yes

No

If so, explain terms of probation(Required)

EDUCATION, SPECIAL SKILLS AND QUALIFICATIONS.(Required)

EMPLOYMENT HISTORY

Start with the present or last position.

Employer 1

Employer

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Supervisor

Employment Time From

Employment Time To

Duties

Reason for leaving

Employer 2

Employer

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Supervisor

Employment Time From

Employment Time To

Duties

Reason for leaving

Employer 3

Employer

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Supervisor

Employment Time From

Employment Time To

Duties

Reason for leaving

REFERENCES

Exclude Relatives.

Reference 1

Name

First Last

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Reference 2

Name

First Last

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Reference 3

Name

First Last

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

(If you are employed, you will be asked to submit a copy of your Dept. of Motor Vehicle Driving Report). COPY OF YOUR DRIVER’S LICENSE TO BE SUBMITTED WITH THIS APPLICATION.

YOU AGREE TO SUBMIT TO A PRE-EMPLOYMENT DRUG TEST AT YOUR EXPENSE AND IF THE TEST IS NEGATIVE, MURPHY CLEARING & GRADING WILL REIMBURSE YOU, AND YOU ALSO AGREE TO RANDOM DRUG TESTING – THIS IS A DRUG-FREE COMPANY.

I CERTIFY THAT THE INFORMATION CONTAINED ON THIS APPLICATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT ANY FALSE INFORMATION ON THIS APPLICATION MAY BE GROUNDS FOR NOT HIRING ME.

Date(Required)

Signature(Required)

EMERGENCY CONTACT INFORMATION

Emergency Contact Information

Name

First Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Home #

Work #

Cell #

Physician Information

Name

First Last

Phone

Known Medical Conditions

Known Allergies

Daily Medications

DISCLOSURE AND AUTHORIZATION

Full Name Printed(Required)

Signature(Required)

Date(Required)