2647 225th St.
Dewitt, Iowa  52742
PHONE: 563-659-9181

Wendling Quarries
General Employment Application

APPLICATION FOR EMPLOYMENT

NOTE TO THE APPLICANT: This application is used to evaluate your qualifications for employment. Please answer all of the questions on your application accurately. If you fail to do so, you may lose employment opportunities or delay consideration of your employment. This application is not an employment contract. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, disability, age, sex, or any other classification protected by federal, state, or local laws. Additional testing of job-related skills, as well as post-offer pre-employment physical (which will include a drug test) may be required.
Desired Position: Date:

A. PERSONAL INFORMATION

First Name: Last:
Social Security Number:
Address:  Street/Apt.#
  City: 
  State:    Zip Code: 
Telephone Number: Day: Evening:  Cell: 
Are you at least 18 years of age? Yes  No
Are you at least 21 years of age? Yes  No
Are you eligible for employment in the United States? Yes  No
Do you speak, read, or write fluently in a language other than English? Yes  No
If so, describe ability and list languages.
Who referred you to W.Q.I.?
B. CRAFT TRAINING, EXPERIENCE, AND READINESS TO WORK
On what date would you be available to start work? Date:
Have you worked for this company before? Yes  No     If yes, where?
Date of previous employment. From:   To:
Reason for leaving?
Are you available to work? Full Time     Part Time     Summer Only     Temporary
Are you on lay-off and subject to recall? Yes  No
Can you travel if a job requires it? Yes  No
Would you accept employment? Out-of-town   Statewide
Do you have a valid driver's license? Yes   No
If yes, please specify: Operating License     Commercial Driver's License
List the following: License number:   Sate of issue:
  Expiration Date:
Have you had a motor vehicle accident or moving violation in the last 5 years? Yes  No
If yes, explain:
What types and makes/models of construction equipment can you operate or repair?
List any craft training programs in which you have participated:
 

C. Employment

Your training and employment experience will be used to determine whether you meet the entrance requirements for this position and to measure your knowledge, skills, and abilities in completing for this position. Therefore, please provide a full and accurate description of the responsibilities and achievements in your jobs and other pertinent life experiences. Include self-employment, volunteer experience, and any non-employment periods.

List your three most recent positions held, starting with the most recent employer first.
Date: Employer Name:
  Address:
  Employer phone:
  Position held/duties:
  Supervisor's name:
  May we contact: Yes  No
  Starting pay:    Ending pay:
  Reason for leaving:

          __________________________________________________________________________

Date: Employer Name:
  Address:
  Employer phone:
  Position held/duties:
  Supervisor's name:
  May we contact: Yes  No
  Starting pay:    Ending pay:
  Reason for leaving:

    __________________________________________________________________________

Date: Employer Name:
  Address:
  Employer phone:
  Position held/duties:
  Supervisor's name:
  May we contact: Yes  No
  Starting pay:    Ending pay:
  Reason for leaving:
REFERENCES: Include only individuals familiar with your work ability. Do not include relatives.
Name:

     1.

  

Address/Phone:  Years Known:

     2. Address/Phone:   Years Known:
SPECIAL SKILLS AND QUALIFICATIONS:
Summarize special skills and qualifications acquired from employment or other experience:
Do you have your own craft tools, clothing, and other equipment? Yes  No
Have you attended High School, Vocational/Training School or College? Yes  No
If yes, please specify:

CERTIFICATION & RELEASE

I certify that the information contained in this application are true, complete, and accurate. I understand that, if employed, false statements or omissions on this application may result in rejection of my application or discharge at any time during my employment.

I authorize investigation of all statements contained herein. I further authorize all individuals, companies, schools, corporations, courts, law enforcement, and all state motor vehicle agencies to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise. I release all parties from all liability for any damage that may result from divulging or using information.

I understand and agree that, if hired, my employment is for no definite period and either I or the company can terminate the employment relationship at any time, with or without cause, and with or without notice. This employment relationship exists regardless of any other statements or policies to the contrary.

I realize that under certain provisions of Iowa law, I may be required to submit to a post offer pre-employment physical (which will include a drug test) as a condition of my employment. I hereby agree to submit to such an examination if required so by company policy and permit disclosure of the results to the company.
Signature: Date:
Typing your name in the above box constitutes an electronic signature and is treated in the same manner as an actual hand written signature.
(Note: This application will be active for 6 months)
This company does not unlawfully discriminate in hiring or any aspect of the employment relationship on the basis of age, race, color, sex, religion, national origin, disability, or any other basis protected by law in the jurisdiction in which the employment is performed.
AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER