Welcome What We Do Projects Equipment Contact Employment Opportunities JULIAN M JOHNSON CONSTRUCTION Est. 1953 / SBE Certified EMPLOYMENT APPLICATION Please complete the entire application. It is the policy of Julian M. Johnson Construction Corp. to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status. 1. Employer Information Employer: Julian M. Johnson Construction Corp. Address: 6191 140th Avenue NW City/State/ZIP: Ramsey, Minnesota 55303 Telephone: (763) 323-2900 2. Applicant Information Applicant Full Name: ___________________________________________ Home Address: ___________________________________________ City/State/ZIP: ___________________________________________ Number of years at this address: _________ Daytime phone: ____________________ Evening phone: ____________________ Mobile phone: ____________________ Driver's License (State/Number): ___________________________ 3. Emergency Contact: Who should be contacted if you are involved in an emergency? Contact Name: ___________________________________________ Relationship to you: ___________________________________________ Address: ___________________________________________ City/State/ZIP: ___________________________________________ Daytime phone: ____________________ Evening phone: ____________________ 4. Job Position Applied For:____________________________________ Full or Part Time? ____________________________________ 5. Salary Desired: $ ____________ per _______________________________________________ 6. Who referred you to our company? ______________________________________ Do you have any friends or relatives who work here? If yes, please list here: ___________________________________________________________ 7. Are you at least 18 years old? ______ Yes ______ No 8. How will you get to work?_____________________________________ 9. If applicable, are you available to work overtime? _____ Yes _____ No 10. If you are offered employment, when would you be available to begin work? 11. If hired, are you able to submit proof that you are legally eligible for employment in the United States? _____ Yes _____ No 12. Applicant's Skills List any skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.) List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application. Skill_______________________ Years of Experience_____ Ability or Rating 1 2 3 4 5 Skill_______________________ Years of Experience_____ Ability or Rating 1 2 3 4 5 13. Applicant Employment History Employer Name: ___________________________________________ Supervisor Name: ___________________________________________ Address: ___________________________________________ City/State/ZIP: ___________________________________________ Job Duties: ___________________________________________ Reason for Leaving: ___________________________________________ Dates of Employment (Month/Year): _____________________________ Employer Name: ___________________________________________ Supervisor Name: ___________________________________________ Address: ___________________________________________ City/State/ZIP: ___________________________________________ Job Duties: ___________________________________________ Reason for Leaving: ___________________________________________ Dates of Employment (Month/Year): _____________________________ Employer Name: ___________________________________________ Supervisor Name: ___________________________________________ Address: ___________________________________________ City/State/ZIP: ___________________________________________ Job Duties: ___________________________________________ Reason for Leaving: ___________________________________________ Dates of Employment (Month/Year): _____________________________ 14. Applicant's Education and Training College/University Name and Address ____________________________________________________________ Did you receive a degree? ______ Yes _____ No If yes, degree(s) received:___________ High School/GED Name and Address ____________________________________________________________ Did you receive a degree? ______ Yes _____ No Other Training (graduate, technical, vocational): ____________________________________________________________ Please indicate any current professional licenses or certifications that you hold: ____________________________________________________________ Awards, Honors, Special Achievements: ____________________________________________________________ 15. References List any two non-relatives who would be willing to provide a reference for you. Name: ___________________________________ Address: ___________________________________ City/State/ZIP: ___________________________________ Telephone: _______________________ Relationship: _______________________ Name: ___________________________________ Address: ___________________________________ City/State/ZIP: ___________________________________ Telephone: _______________________ Relationship: _______________________ 16. Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer: ____________________________________________________________ ____________________________________________________________ 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 Julian M. Johnson Construction Corp. to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. 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 right. Moreover, no agent, representative, or employee of Julian M. Johnson Construction Corp., 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. ____________________________________ _______________ APPLICANT SIGNATURE DATE