Name
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First Name
Last Name
Street Address:
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City
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State
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Zip Code
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How long at present address?
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Daytime phone number
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Evening phone number
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Email
Do you have the legal right to work in the United States?
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Note: Bertolet Construction, LLC requires all employees have the legal right to work in the United States.
Do you have a valid driver's license?
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Note: Due to the nature of our work, a valid driver's license and your own reliable transportation is required for employment.
Do you have your own transportation?
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Do you have any limitations regarding the hours that you can work?
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If yes, explain.
Do you have any travel restrictions?
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If yes, explain.
Have you ever been conviction of a Felony?
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If yes, explain.
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Note: A conviction record will not necessarily be a prohibition to employment. Applicants with a sealed record on file may answer "no record" to any inquiries about criminal charges. A Pennsylvania criminal background check, Pennsylvania Child Abuse Clearance and federal criminal history check will be obtained upon hire and yearly thereafter as required by Act 34 and Act 151.
If offered the position are you willing to take and consent to a physical examination and drug test?
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Position Desired
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Please let us know what position(s) you are interested in.
When are you available to start?
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MM
DD
YYYY
Referred by?
Select the highest level completed
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Elementary School
Middle School
9th Grade
10th Grade
11th Grade
Earned High School Diploma
Earned GED
College 1 Year
College 2 Years
College 3 Years
College 4 Years
Post College/Graduate School
High School Name and Address
College Name and Address: (if applicable)
Trade School Name and Address: (if applicable)
List any ability, experience or aptitude that you believe would be helpful in the job for which you are applying
Current, or last employer name
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Address
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City
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State
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Zip code
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Employment start date
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MM
DD
YYYY
Employment end date
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Position held
*
Brief description of your responsibilities
*
Reason for leaving
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Contact for reference
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First Name
Last Name
Reference phone number
*
(###)
###
####
Compensation: ($/week, $/hour or $/year)
*
Previous Employer (1)
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Address
*
City
*
State
*
Zip code
*
Employment start date
*
Employment end date
*
Position held
*
Brief description of your responsibilities
*
Reason for leaving
*
Contact for reference
*
First Name
Last Name
Reference phone number
*
(###)
###
####
Compensation: ($/week, $/hour or $/year)
*
Previous Employer (2)
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Address
*
City
*
State
*
Zip code
*
Employment start date
*
Employment end date
*
Position held
*
Brief description of your responsibilities
*
Reason for leaving
*
Contact for reference
*
First Name
Last Name
Reference phone number
*
(###)
###
####
Compensation: ($/week, $/hour or $/year)
*
Previous Employer (3)
Address
City
State
Zip code
Employment start date
Employment end date
Position held
Brief description of your responsibilities
Reason for leaving
Contact for reference
First Name
Last Name
Reference phone number
(###)
###
####
Compensation: ($/week, $/hour or $/year)
Explain any gaps in your employment, other than those due to personal illness, injury or disability.
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1st Reference
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First Name
Last Name
Address
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Phone
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(###)
###
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2nd Reference
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First Name
Last Name
Address
*
Phone
*
(###)
###
####
3rd Reference
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First Name
Last Name
Address
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Phone
*
(###)
###
####
License number
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State
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Endorsements
A) Have you ever been denied a license, permit or privilege to operate a motor vehicle?
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B) Has any license, permit or privilege ever been suspended or revoked?
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If yes to either A or B, please explain.
Have you been involved in an auto accident in the past 3 years?
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Have you had any traffic convictions or forfeitures (other than parking violations) in the past 3 years?
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List dates and types of equipment operated. If none, enter none.
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List any additional information such as courses or training taken, awards received, special equipment or technical materials you can work with, any other experience that may help in your work for this company. If none, enter none.
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Date of Submission
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MM
DD
YYYY
By checking this box I am signing this application and I agree to the terms described above.
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