Home Services Projects Careers Application About Us Employee Resources Contact Us Today Application Home Application EN ES PERSONAL INFORMATION Last Name * First Name * M.I. Date * Address * APT. # City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * Cell Phone * Home Phone Email * Are You A U.S. Citizen? * Yes No If no, are you authorized to work in the U.S.? Yes No Have you ever worked for this company? * Yes No If yes, when: Are you 18 years of age or older? * Yes No If employed, do you expect to be engaged in any additional business or employment outside of our job? * Yes No If yes, give details POSITION Position Applied For Available Start Date Desired Salary FOR DRIVING JOBS ONLY Do you have a valid driver license? Yes No Driver’s License Number Class of License no State Licensed in Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Have you had your driver’s license suspended or revoked in the last 3 years? Yes No If yes, give details Education High School Location Degree Years Attended Did you graduate? Yes No College Location Degree Years Attended Did you graduate? Yes No Technical School Location Degree Years Attended Did you graduate? Yes No Other (specify) Location Degree Years Attended Did you graduate? Yes No What skills or additional training do you have that relate to the job for which you are applying? What machines or equipment can you operate that relate to the job for which you are applying? Previous Employment Company (1) Job Title Phone Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Supervisor Dates Employed: From Dates Employed: To Ending Salary Duties / Responsibilities Reason for Leaving May we contact your previous supervisor for a reference? Yes No Company (2) Job Title Phone Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Supervisor Dates Employed: From Dates Employed: To Ending Salary Duties / Responsibilities Reason for Leaving May we contact your previous supervisor for a reference? Yes No Company (3) Job Title Phone Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Supervisor Dates Employed: From Dates Employed: To Ending Salary Duties / Responsibilities Reason for Leaving May we contact your previous supervisor for a reference? Yes No References Full Name Relationship Company Phone Full Name Relationship Company Phone Full Name Relationship Company Phone Background Check Required Information Date of Birth * Voluntary Self-Identification of Race and Ethnicity In order to comply with certain federal recordkeeping and reporting requirements, Premier Earthworks & Infrastructure invites employees to identify their ethnicity and race. Please fill out this form and return it to your hiring manager Providing the information below is optional and based on your self-identification. If you choose to participate, please answer both questions by checking the appropriate box or boxes. Thank you for your cooperation. Are you Hispanic or Latino? Yes, Hispanic or Latino No, not Hispanic or Latino What is your race? (select one or more) American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Definitions Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America) who maintains cultural identification through tribal affiliation or community attachment. Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. Black or African American: A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. How does Premier use this information? Premier Earthworks & Infrastructure uses race and ethnicity information for annual reports and to meet its Affirmative Action goals. Premier Earthworks & Infrastructure does not share specific race and ethnicity or other personal information with outside agencies. The ethnicity and race data you choose to provide here will be used only in accordance with applicable laws, executive orders, and government regulations. As per Premier Earthworks & Infrastructures (PEI) Nondiscrimination Policies, PEI does not discriminate or permit harassment on the basis of race, color, alienage and citizenship, gender, or any other legally protected status. Disclaimer And Signature I certify that my answers are true and complete to the best of my knowledge. I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment drug examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE PRESIDENTOF THE ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE PRESIDENT AND THE EMPLOYEE. IF EMPLOYED I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. Signature * About Us PEI is a one-stop contractor that self-performs all aspects of horizontal development in house. Contact Us P.O. Box 9382 Denver, CO 80209 (303) 993-6349 Office Location 5600 South Quebec Street Unit #107A Greenwood Village, CO 80111 Get Directions Shop Location 2322 South Denver Fort Lupton, CO 80621 Get Directions © 2019 Premier Earthworks & Infrastructure