Allen Contracting HOME HISTORY PROJECTS SAFETY EMPLOYMENT CONTACT ALLEN CONTRACTING & SHELL CONSTRUCTION APPLICATION Personal Information Last Name* First Name* M.I. Address* City* State* -- Select a 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* Phone* Email* Date You Can Start Referred By* Position Applying For Salary Desired Are you 18 years of age or older? YesNo Are you a citizen of the United States? YesNo Have you ever worked for Allen Contracting/Shell Construction? YesNo Do you have any friends/relatives that work for Allen Contracting/Shell Construction? YesNo Are you willing to travel within the state of Oklahoma? YesNo Do you have reliable transportation? YesNo Are you willing to work 40-60 hours per week on a regular basis? (May include weekends) YesNo What languages do you speak fluently? English Spanish Other Have you ever been convicted of a felony? YesNo Education High School* City* State* -- Select a 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 From* To* Did you Graduate?* YesNo Diploma* College/Trade School City State -- Select a 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 From To Did you Graduate? YesNo Degree Experience Operator Bulldozer Roller Backhoe Motor Grader Scraper Loader Certified Crane Years Laborer Skilled Unskilled Years Truck Driver Truck/Trailers Dump Truck Concrete Mixer Years Craft Worker Concrete Finisher Pipe Layer Carpenter Form Builder Asphalt Years Clerical MS Excel MS Word MS Outlook MS Office Years Please list other special training and/or skills related to the position to which you are applying: References Please list three professional references Reference 1 Name* Company* Relationship* Phone* Reference 2 Name* Company* Relationship* Phone* Reference 3 Name Company Relationship Phone Previous Employment All applicants: Must show at least past 7 years of job history. List current or most recent job first. Explain gaps in employment. Previous Employment 1 Company Address City* State* -- Select a 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 Supervisor Job Title* Starting Salary Ending Salary From To Responsibilities Rason for Leaving May we contact your previous supervisor for a reference? YesNo Previous Employment 2 Company Address City* State* -- Select a 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 Supervisor Job Title* Starting Salary Ending Salary From To Responsibilities Reason for Leaving May we contact your previous supervisor for a reference? YesNo Previous Employment 3 Company Address City State -- Select a 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 Supervisor Job Title Starting Salary Ending Salary From To Responsibilities Reason for Leaving May we contact your previous supervisor for a reference? YesNo Explain any gaps in employment Authorization I authorize investigation on all statements contained in this application. I understand that misrepresentation of information requested is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may; regardless of the date of payment of my wages and salary, be terminated at any time without case and without any previous notice.* Voluntary Identity Self Disclosure Allen Contracting, Inc. / Shell Construction Company, Inc. are contractors subjected to the rules and regulations of U.S. Government Executive order 11246, as amended, which requires the company to employ, upgrade, transfer, promote, layoff, or terminate without regard to race, age, color, religion, sex, disability, or national origin. The U.S. Government requires Allen Contracting, Inc. / Shell Construction Company, Inc. to maintain the information requested below for the purpose of determining the impact of Allen Contracting, Inc. / Shell Construction Company, Inc. employment procedures. This information will be kept confidential. It will be filed separately from your application form and if employed, separate from your personnel file. This information will only be used in accordance with prescribed federal regulations. NOTE: The information requested in this form is completely voluntary and will be kept confidential. We will use the data you provide us for periodic government reporting purposes only. Also, this form will be stored separately from each employee’s personnel file. Refusal to provide this information will NOT subject you to any adverse treatment. However, your cooperation in this would be greatly appreciated. Name Date of Birth Position Applying For Race Alaskan or American Indian Asian Black or African American Hawaiian or Pacific Islander Hispanic or Latino White or Caucasian Two or More Races Military Service Branch From To Rank at Discharge Type of Discharge If other than honorable, explain Background Investigation Release In connection my application for employment with Allen Contracting, Inc. / Shell Construction Company, Inc., I hereby agree to the following: This authorization and consent for release of personal information acknowledges that Allen Contracting, Inc. & Subsidiaries, hereafter referred to as "Company" and/or its agent, Investigative Concepts, Inc., may now, or at any time I am assigned to or am employed by this Company, run a "consumer report" and/or an "investigative consumer report". These investigations whether the records are of a public, private or confidential nature, may include, but are not limited to, information about your character, general reputation, personal characteristics and searches of educational institutions attended to obtain an academic record, state driving records, records of previous employment, including work history, efficiency ratings, complaints and grievances filed by or against me; records and recollections of attorney-at-law or of other counsel, whether representing me or any other person (in either a civil or criminal case in which I have been involved); records from the U.S. Veterans' Administration; and criminal history information on file in local, state or federal agencies. I understand that a workers' compensation report may be obtained from either the Department of Labor, National Personnel Records, the Industrial Commission or similar agencies under the provisions of the Fair Credit Reporting Act 15, USC section 1681 et seq. I further authorize, in accordance to DOT Regulations, my DOT regulated drug and alcohol testing records, including but not limited to, a limited query of FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse and information directly from my previous employers regarding any positive drug test, any refusal to be tested and any other violations of the DOT regulations, occurring in the previous 3 years. I authorize all records to be released to Investigative Concepts, Inc. Acknowledgement and Authorization I understand that these searches will be used to determine work assignment or employment eligibility under the Company's employment. I hereby mithnri7e and ronsent to the obtaining of a "Investigative Consumer Report" and/or a "Consumer Report" at any time after receipt of this authorization. In addition, I release and discharge the Company and its agent/associates to the full extent permitted by law from any claims, damages, losses, liabilities, costs expenses or any other charge or complaint filed with any agency arising from retrieving and reporting this information. I understand that I have no guarantee of employment and that Allen Contracting, Inc. / Shell Construction Company, Inc. may determine not to hire me for any lawful reason. I hereby swear that all information that I submit to Company & /or its agent Investigative Concepts is true and correct to the best of my knowledge. I understand that I may request a copy of the report from Investigative Concepts, Inc, at P.O. Box 471832 Tulsa, OK or telephone number 918-286-7059. I understand If I am applying for employment in Oklahoma or Minnesota I may request a copy of Consumer Report. To request a copy mark "yes" to the following. I request a copy of my consumer report. I authorize you to contact my current and past employers for Employment and Reference Verifications. (This will authorize immediate inquiries to the Human Resources Department and to any listed supervisors or references in the Employment/Reference Section of your application.) I also agree that this Disclosure and Authorization in original, faxed, photocopied, or electronic (including electronically signed) form will be valid for any consumer reports or investigative consumer reports that may be requested about me by or on behalf of Allen Contracting, Inc. & Subsidiaries. Last Name* First Name* M.I. Address* City* State* -- Select a 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* Date of Birth* Drivers License* State* -- Select a 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 Class I agree with the above statement.* Please PRINT and SIGN the above Background Consent Form. Either Fax to (405) 231-1757 or email to Lindsey.Niebrugge@allen-contracting.com 516 W. CALIFORNIA AVE. OKLAHOMA CITY, OK 73102 O: 405.677.4450 F: 405.677.5006 EMAIL US ©2021 Allen Contracting. Website design, support and hosting by Back40 Design.