Roughneck Employment Application

ROUGHNECK CONCRETE DRILLING AND SAWING COMPANY is an Equal Opportunity Employer. ROUGHNECK CONCRETE DRILLING AND SAWING COMPANY does not discriminate on the basis of race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

Personal Information		* required information
	First Name *
	Middle Name *
	Last Name *
	Nickname
	Email Address *
	Street Address *
	Apt. / Building #
	City *
	State *
	Zip *
	Home Phone Number *
	Alternate Phone Number
	Identify (i.e., friend, relative)
	Have you been convicted of a Felony? * (Prior convictions are not necessarily a bar to employment consideration)	Yes No
	If yes, please explain (include dates)
	Misdemeanor? *	Yes No
	Been on Parole?	Yes No
	DL# *
	State *
	List all driving violations or accidents in the past 5 years (include dates)

Employment Preferences
	Are you available to work overtime(more than 40 hours per week)? *	Yes No
	Are you available to work with little or no notice? *	Yes No
	Are you available to work nights? *	Yes No
	Position applied for
	Salary Information: Previous $ hourly rate *
	Minimum $ hourly rate accepted *

Educational History
Please list most recent education first
1.)	Name of School *
	Location *
	Completion Level / Degree *
	Subject / Training
	GPA *
	Scale
	Diploma / Degree *	Yes No

2.)	Name of School
	Location
	Completion Level / Degree
	Subject / Training
	GPA
	Scale
	Diploma / Degree	Yes No

Employment History
Please list most recent employment first
1.)	Employer *
	Location *
	Length of Employment *	Start Date End Date
	Presently Employed *	Yes No
	Starting Salary *
	Ending Salary *
	Additional Bonus *
	Position Title *
	Department / Division *
	Supervisor's Name and Title *
	Phone Number *
	Reason For Leaving *

2.)	Employer
	Location
	Length of Employment	Start Date End Date
	Presently Employed	Yes No
	Starting Salary
	Ending Salary
	Additional Bonus
	Position Title
	Department / Division
	Supervisor's Name and Title
	Phone Number
	Reason For Leaving

3.)	Employer
	Location
	Length of Employment	Start Date End Date
	Presently Employed	Yes No
	Starting Salary
	Ending Salary
	Additional Bonus
	Position Title
	Department / Division
	Supervisor's Name and Title
	Phone Number
	Reason For Leaving

4.)	Employer
	Location
	Length of Employment	Start Date End Date
	Presently Employed	Yes No
	Starting Salary
	Ending Salary
	Additional Bonus
	Position Title
	Department / Division
	Supervisor's Name and Title
	Phone Number
	Reason For Leaving

5.)	Employer
	Location
	Length of Employment	Start Date End Date
	Presently Employed	Yes No
	Starting Salary
	Ending Salary
	Additional Bonus
	Position Title
	Department / Division
	Supervisor's Name and Title
	Phone Number
	Reason For Leaving

Resume
	Attach Your Resume


		By submission the Applicant/employee authorizes Roughneck Concrete Drilling & Sawing to obtain and review motor vehicle records (MVR) on a regular basis.

* required information

Roughneck Employment Application

Personal Information

Employment Preferences

Educational History

Employment History

Resume