Position Applied For*
Today's Date*
Phone
First Name*
Middle Initial*
Last Name*
Street Address*
Address Line 2
City*
State*
Zip Code*
Email Address*
Social Security Number
Do you have the legal right to work in the United States?* YesNo
Are you 18 years of age or older?* YesNo
Have you worked for this company before?* YesNo
If yes, state when, where, what projects you worked on, and with whom.
List any friends or relatives other than spouse working for us.
Select the option that represents the highest level of completed educational background.* High SchoolGEDTrade/Business SchoolCollegeOther
If you selected "Other" from the options above, please specify:
Enter School Information:
List any special qualifications, licenses, or other information which may help you qualify for the position.
List any equipment or machinery you can operate.
May we contact?* YesNo
If yes, provide phone number:
Reason for leaving*
List two people not related to you whom you have known for at least 1 year.*
I certify that the facts set forth in this Employment Application are true and complete to the best of my knowledge. I understand that falsification, omissions or misstatements may prevent my being hired, or if already hired, may subject me to dismissal. I authorized Park Construction Company to make a thorough investigation of my entire work history, and to verify all data given in my application for employment. I release from liability any person giving or receiving information regarding my personal history, medical information and prior work record. I understand and agree that my employment is for no definite period of time and may be terminated by this company at any time without liability for wages or salary except such as may have been earned at the date of termination. I understand that, if hired, I will abide by all the rules and regulations of Park Construction Company. I accept
I (Name) accept the terms above.
First Name* Last Name* Today's Date*
Federal and state laws and regulations prohibit discrimination in employment because of race, color, sex, religion, national origin, age, ancestry, creed, affectional preference, marital status, sexual orientation, status with regard to public assistance, physical or mental handicap, or disabled veteran status.
As an employer/government contractor, we must comply with government regulations and affirmative action responsibilities. The information requested below will be used to determine if our recruitment efforts are reaching all segments of the community and will meet our reporting requirements. The information will be used and kept confidential in accordance with the applicable laws and regulations, including those that require the information to be summarized and reported to the Federal Government for Civil Rights enforcement. When reported, the data will not identify any specific individual. This information is voluntary.
First Name Middle Initial Last Name
Check one: MaleFemaleI choose not to declare
Ethnicity African-AmericanAmerican Indian/Native AlaskanAsian/Pacific IslanderCaucasianHispanicMore than oneI choose not to declare
Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Asian (Not Hispanic or Latino) - 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.
American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races.
Voluntary Self-Identification of Disability Yes, I have a disability, or have had one in the pastNo, I do not have a disability and have not had one in the pastI choose not to declare
A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:
Alcohol or other substance use disorder (not currently using drugs illegally)
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
Blind or low vision
Cancer (past or present)
Cardiovascular or heart disease
Celiac disease
Cerebral palsy
Deaf or serious difficulty hearing
Diabetes
Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
Epilepsy or other seizure disorder
Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
Intellectual or developmental disability
Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
Missing limbs or partially missing limbs
Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
Partial or complete paralysis (any cause)
Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
Short stature (dwarfism)
Traumatic brain injury
Military Veteran (select all that apply)
Not a VeteranRecently Separated VeteranVietnam Era VeteranWar/Campaign/Expedition VeteranArmed Forces Service Medal VeteranI choose not to declare
Military Branch and Rank
Referral Source (select all that apply) Employment AgencyCommunity AgencyNewspaper AdOnline ApplicationPark EmployeeJob ServiceCollege RelationsRehireUnion Hall
