Lee Hy Construction

Section 1: Personal Information

Full name*

Home address*

City*

State*

Zip code*

How long at this address?*

Are you 18 or over?* Yes No

Telephone*

E-mail*

Position applied for*

Desired wage or salary*

Are you presently employed? If yes, where?*

When are you available for work?*

How did you hear about this job opening?
(If individual, please list name)*

Please use the space below to summarize any information you feel helps to describe your skills and qualifications for the specific position for which you are applying.

Section 2. Education

High School

Name of High School*

Location*

Number of Years Completed*

College

Name of School

Location

Number of Years Completed

Major & Degree

Other

Name of School

Location

Number of Years Completed

Major & Degree

Section 3. Motor Vehicle Record

Do you have a valid driver's license?* Yes No

Section 4. References

Please list (2) two references other than relatives, who have known you for at least one year.

Reference 1

Name*

Relationship*

Telephone*

Reference 2

Name*

Relationship*

Telephone*

Section 5. Employment History

Please list your work experience for the past five years beginning with your most recent or current employer. Attach additional sheets if necessary.

Work Experience 1

Name of Employer*

City*

State*

Telephone*

Supervisor's Name*

Start Date*

End Date*

Hourly wage or salary*

Title*

Reason for leaving (be specific)*

List the jobs you held, duties performed, skills used or learned, advancements/promotions while employed.*

Add second work experience? Yes No

Add third work experience? Yes No

May we contact your present and/or previous employers?* Yes No

Did you complete the application yourself? If no, who did?*

Section 6. Application Form Waiver

I certify that all the information submitted by me on this application is true and complete. I authorize investigation of all statements contained in this application and a background check. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contact.

In consideration of my employment, I agree to conform to the Company's rules and regulations, and I agree that my employment and compensation can be terminated by the Company with or without cause and with or without notice at any time. I also understand and agree that the terms and conditions of my employment may change with our without cause, and with or without notice, at any time by the Company.

I also understand that (1) the Company has a drug and alcohol policy that provides for preemployment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy.

I further understand that continued employment may be based on the successful passing of job-related physical examinations. I further understand that, should I begin employment with the Company, my employment shall be probationary for a period of (90) ninety days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

I understand that no Company representative, other than it's president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

Signature of applicant* Date*

Section 7. Equal Opportunity Employment

Lee Hy Construction Corporation is an equal opportunity employer. It is the Company's policy to provide equal employment opportunities to all applicants and employees without regard to race, religion, color, creed, marital status, national origin, citizenship, age, sex, physical handicap, medical condition, veteran status, pregnancy, sexual preference or any other classification protected by applicable local, state or federal employment discrimination laws. This policy applies to all aspects of employment including, but not limited to, hiring, job assignment, compensation, promotion and demotion, benefits, training and termination of employment.

The following information is voluntary on the part of Applicant, and will allow Lee Hy Construction to accurately track application data in accordance with OFCCP Executive Order 11246 This information will be used only for the explicit purpose stated above.

Date*

Applicant Gender Male Female Care not to disclose

Applicant Race

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