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To apply for any position, fill out the form below:

    Please answer all questions. Resumes are not accepted in lie of completion of this application.
    Note: This application was designed for use with several types of positions. Some questions may not be completely applicable to the position you are seeking; however, we ask that you answer all questions.

    Applicant Information

    LAST NAME *

    FIRST NAME *

    MIDDLE INITIAL

    DATE

    ADDRESS *

    CITY *

    STATE*

    ZIP CODE *

    EMAIL ADDRESS *

    PHONE NUMBER *

    Date available to start employment: *

    Desired Salary *

    Position(s) Applied For*

    Dirt ForemanPipe Backhoe OperatorGrade CheckerService LaborerConcrete ForemanFinish Loader OperatorProject ManagerMechanicGeneral LaborerService TechGrade ForemanFinish Dozer OperatorPipe LayerConcrete SuperintendentHeavy Equipment Power Wash TechnicianPipe Foreman

    Are you a citizen of the United States?YESNO If NO, are you authorized to work in the U.S.? YESNO
    Have you ever worked for this company? YESNO If Yes, when?:
    Have you been convicted of any felony? YESNO

    If YES, give dates and explain. (Attach separate paper if necessary.) A Conviction will not necessarily disqualify you from employment.

    Education

    High School:

    Address:

    From:

    To:

    Did you graduate?

    YESNO

    Diploma (GED):

    College:

    Address:

    From:

    To:

    Did you graduate?

    YESNO

    Degree:

    Other:

    Address:

    From:

    To:

    Did you graduate?

    YESNO

    Degree:

    Other:

    Address:

    From:

    To:

    Did you graduate?

    YESNO

    Degree:

    References

    How did you learn about career opportunities at Burgess civil? (check all that apply)

    Referral (Name)

    Temporary Agency (Name)

    Internet (Website)

    Other (Explain)

    Provide three (3) references:

    Full Name:

    Relationship:

    Contact Number:

    Full Name:

    Relationship:

    Contact Number:

    Full Name:

    Relationship:

    Contact Number:

    Previous Employment

    List each job held. Start with your present or last job. Include military experience. If known by any other name, please indicate.
    Employer 1

    Company

    Phone

    ADDRESS

    SUPERVISOR*

    JOB TITLE

    SALARY START

    SALARY FINAL

    Responsibilities

    DATE FROM

    DATE TO

    REASON FOR LEAVING

    May we make inquiries of this employer? YESNO

    Employer 2

    Company

    Phone

    ADDRESS

    SUPERVISOR*

    JOB TITLE

    SALARY START

    SALARY FINAL

    Responsibilities

    DATE FROM

    DATE TO

    REASON FOR LEAVING

    May we make inquiries of this employer? YESNO

    Employer 3

    Company

    Phone

    ADDRESS

    SUPERVISOR*

    JOB TITLE

    SALARY START

    SALARY FINAL

    Responsibilities

    DATE FROM

    DATE TO

    REASON FOR LEAVING

    May we make inquiries of this employer? YESNO

    Employment Questions

    Have you been dismissed or forced to resigned from any employment? YESNO If Yes, please explain.

    Are you currently employed? YESNO Are you on layoff and subject to call? YESNO

    Are there any hours, shifts, or days you will not work? YESNO If Yes, please explain.

    Will you work overtime if asked? YESNO

    Do you have any friends or relatives who work here? YESNO If Yes, please fill out their information below.

    NAME

    RELATIONSHIP

    NAME

    RELATIONSHIP

    List below any other information or remarks that you wish to have considered as part of your application for employment.

    Have you been interviewed here before? YESNO If Yes, give date:
    Do you have a reliable method of getting to work? YESNO
    Can you perform the duties of the job you are applying for? YESNO

    Disclaimer and Signature

    NOTICE TO ALL APPLICANTS
    We comply with the American With Disabilities Act of 1990. During the interview process, you may be asked questions concerning your ability to perform job-related functions. If you are given a conditional offer of employment, you may be required to complete a post-job offer medical history questionnaire and/or undergo a medical examination. If required, all entering employees in the same job category will be subject to the same medical questionnaire and/or examination and all information will be kept confidential and in a separate file.

    We are an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard of race, color, sex, religion, national origins, handicap, marital status or sexual orientation. We assure you that your opportunity for employment with Burgess Civil depends solely upon your qualifications.

    If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I certify that my answers are true and complete to the best of my knowledge.

    Signature

    Applicant’s Initials.

    DATE