Application for Employment

• High School Name*
• High School Location
• # of Years Attended
• Subject Studied

• College Name*
• College Location
• # of Years Attended
• Subject Studied

• Other School Name*
• Other School Location
• # of Years Attended
• Subject Studied

• What Other Education, Training, or Experience do you have ?*

• Employer 1 Name*
• Address*
• Date Started*
• Date Ended*
• Salary
• Position*
• Reason for leaving*

• Employer 2 Name
• Address
• Date Started
• Date Ended
• Salary
• Position
• Reason for leaving

• Employer 3 Name
• Address
• Date Started
• Date Ended
• Salary
• Position
• Reason for leaving

• Name of Reference 1*
• Phone Number*
• Years Acquainted*
• Relationship

• Name of Reference 2*
• Phone Number*
• Years Acquainted*
• Relationship

• Name of Reference 3*
• Phone Number*
• Years Acquainted*
• Relationship

By signing this application, I give Senn Blacktop permission to run my driving record and check my References.
A clean driving record is required for employment.

I certify that I have read this form in its entirety and that the information I have provided is true, accurate, and complete to the best of my knowledge. I understand that, should any statement I have made prove to be false, misleading , or erroneous, it may result in the rejection of my application or in my discharge if I am employed regardless of when the false, misleading, or erroneous information is discovered.

I further understand and agree that this application is not a contract for employment, and that any individual hired by Senn Blacktop may voluntarily leave his /her employment or may be terminated by Senn Blacktop at any time for any reason. I understand that, other than a written agreement signed by the president of Senn Blacktop, any oral or written statements to the contrary are not valid, are expressly disavowed, and should not be relied upon by any prospective or existing employee.

• Signature
• Date