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USCC, INCORPORATED

Employment Application

Position Applied For
Field Position Superintendent
General Foreman
Foreman
Journeyman
Welder
General Laborer
Laborer
Office Position
Personal Information
Name (First, Middle Initial, Last)
City
State
Zip code
Telephone #
Emergency Telephone #
Birth Date
Social Security Number
Are you an American Citizen? Yes
No
Are you currently employed? Yes
No
If so, where and how long?
Present/Last Employer
Job 1) Company
Job 1) Date Started
Job 1) Date Ended (if applicable)
Job 1) Address (Street, City, State, Zip Code)
Job 1) Phone #
Job 1) Position/Title
Job 1) Salary
Job 1) Describe Job Position & Duties
Job 1) Reason for Leaving
Previous Employer #2
Job 2) Company
Job 2) Date Started
Job 2) Date Ended (if applicable)
Job 2) Address (Street, City, State, Zip Code)
Job 2) Phone #
Job 2) Position/Title
Job 2) Salary
Job 2) Describe Job Position & Duties
Job 2) Reason for Leaving
Previous Employer #3
Job 3) Company
Job 3) Date Started
Job 3) Date Ended (if applicable)
Job 3) Address (Street, City, State, Zip Code)
Job 3) Phone #
Job 3) Position/Title
Job 3) Salary
Job 3) Describe Job Position & Duties
Job 3) Reason for Leaving
Trade Skills
List those skills, which you feel would qualify you for the job applied for
Other Skills
List other skills Example: Heavy equipment operation or certifications
References
Reference 1) Name
Reference 1) Business
Reference 1) Phone #
Reference 1) Years Known
Reference 2) Name
Reference 2) Business
Reference 2) Phone #
Reference 2) Years Known
Reference 3) Name
Reference 3) Business
Reference 3) Phone #
Reference 3) Years Known
Other Questions
Do you have a valid driver's license? Yes
No

Do you have reliable transportation?

Yes
No


Are you willing to be drug screened?

Yes
No


Have you received treatment for drug or alcohol abuse?

Yes
No


Have you ever been convicted of a felony?

Yes
No

 
USCC, Incorporated
PO Box 369, ELIZABETHTON, TENNESSEE, 37644
PHONE: (423)474-3938, FAX: (423)474-2431
1998 - 2010 All Rights Resreved