Phone: 434-432-8282; Fax: 434-432-2029 HOME ABOUT US SERVICES PROJECTS EMPLOYMENT CONTACT US Equipment EMPLOYMENT APPLICATION THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 3 years. Personal Information First Name Middle Name Last Name Home Phone Work Phone Cell Phone Addresses Mailing Address 1 Street City State Zip Code Employment Information Position Applied For Date You Can Start (yyy-mm-dd) Desired Salary $ Do You Prefer Full-Time Part-Time Either Can you work Weekends Evenings Available M Tu W Th F Sa Su Not Available Please answer all of the following questions. 1. Do you have experience flagging traffic? No Yes If yes, is your certification card valid? No Yes 2. Have you worked for this business before? No Yes If yes, please provide dates 3. Will you travel if this job requires it? No Yes 4. Do you have CPR Certification? No Yes If yes, date received: 5. Do you have First Aid Certification? No Yes 6. Have you ever applied with this company before? No Yes If yes, Dates: 7. Have you ever pled “Guilty” or “No Contest” to, or been convicted of a crime? No Yes If yes, provide details and dates: 8. Are you now, or have you ever been a member of the Armed Forces? No Yes If yes, please list any special training applicable to this job: Employment History Are you currently employed? No Yes May we contact your present employer? No Yes Most Recent Employer Employer City State Zip Code Phone Position Held From (m/yyyy) To (m/yyyy) Pay upon leaving Supervisor Duties Reason for Leaving Prior Employer 1 Prior Employer 2 Prior Employer 3 Job-related Skills Please answer the following questions if the position you are applying for requires driving a motor vehicle 1. Do you have a valid driver's license? No Yes State Expiration 2. Have you been convicted of or pled guilty to any traffic-related offense within the past five years? No Yes If yes, please explain... 3. Do you have a CDL? No Yes If yes, date of last medical exam: 4. Date of last drug test 5. Please list CDL Endorsements, Class and Restrictions in the space below: Please describe experience (month/years) for any of the positions listed below: Articulated Truck, Carpenter, Compactor (Roller), Concrete Finisher, Crane, Dozer, Dump Truck, Excavator, Flagger, Flat Bed, Fuel Truck, Laborer, Loader, Mechanic, Motorgrader, Oiler/Greaser, Pipe Layer, Scraper (Pan), Service Truck Resume (Text Version) Copy and Paste a text version of your resume here. Upload File Attach a file to your application submission (Permitted File Types: doc,docx,pdf,txt - Max file size: 1045876 bytes) Applicant Certification Agreement 1. The company and other persons or employers are released from all liability brought forth by any investigation resulting from my submission of this electronic application and the data contained here in. 2. The information in this application is true and complete to the best of my knowledge. Any falsification, misrepresentation, or omission on this application can be cause for denial or termination of employment. 3. If hired, my employment is voluntary, meaning that either party can employment at any time for any reason. Upon acceptance of employment if a position is offered, I agree to abide by all existing and future company rules and regulations. The company reserves the right to change any working agreement as deemed necessary. 4. Any employment offer is contingent open my providing proof of identity and eligibility to work the country of employ. 5. I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully. 6. I understand that by typing my name in the signature box below and submitting this application electronically, this becomes a legal and binding contract. Security Code Type Name in Signature Box: Date: 2021-12-05 22:27:08 You are here: Home Employment Apply Online VA Licensed Class A Contractor #2701010500 Classifications CIC, H/H, HIC NC Unlimited Licensed General Contractor #7276 H – Highway/Heavy PU – Water & Sewer Lines Haymes Brothers, Inc. 440 Hawkins Rd Chatham, VA 24541 Phone: 434-432-8282 Fax: 434-432-2029 Back to Top © 2021 Haymes Brothers Construction