We Are Seeking Qualified People To Join Our Team Interested in working at Phillips & Koch Construction? Please fill out the application below. Required fields are marked in green. PERSONAL INFORMATION First Name Middle Initial Last Name Maiden Name Email Address Home Address City State Zip Code How long have you lived at your current address? Phone # Emergency # Emergency Contact Name & Relationship If you are under 18 years of age, state your age: Can you prove your U.S. Citizenship? YesNo If NO, please provide your VISA Number and Expiration Date List all of the positions you are applying for: What is your desired salary? How many hours can you work, Weekly? Can you work nights? YesNo Employment-Level desired? Full-Time OnlyPart-Time OnlyFull or Part-Time When are you available for work? EDUCATION AND BACKGROUND INFORMATION High School Name Complete Mailing Address # of Years and Date Completed Major/Degree University / College Name Complete Mailing Address # of Years and Date Completed Major/Degree Business / Trade School Name Complete Mailing Address # of Years and Date Completed Major/Degree Professional School Name Complete Mailing Address # of Years and Date Completed Major/Degree Have you ever been convicted of a crime? YesNo If YES, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation. Have you ever been injured at work? YesNo If yes, explain how and when: Do you have a DRIVER'S LICENSE? YesNo Driver's License Number: State of Issue: Expiration Date: License Type: Operator Commercial (CDL) Chauffeur What is your means of transportation to work? Have you had any accidents during the past three years? YesNo If yes, please explain. Have you had any moving violations during the past three years? YesNo If YES, please explain. References Please list two references other than relatives or previous employers. Name Company & Position Address Telephone # Name Company & Position Address Telephone # An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications and job skills for the specific position for which you are applying. MILITARY Have you ever served in the Armed Forces? YesNo Discharge Date Honorable Discharge? YesNo Specialty Are you now a member of The National Guard? YesNo Date Entered Specialty WORK EXPERIENCE Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Employer #1 Employer Name Address Supervisor's Name Telephone # Dates of Employment (from-to) Pay / Salary Your last Job Title Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements, and/or promotions while you worked at this company. Employer #2 Employer Name Address Supervisor's Name Telephone # Dates of Employment (from-to) Pay / Salary Your last Job Title Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements, and/or promotions while you worked at this company. Employer #3 Employer Name Address Supervisor's Name Telephone # Dates of Employment (from-to) Pay / Salary Your last Job Title Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements, and/or promotions while you worked at this company. Employer #4 Employer Name Address Supervisor's Name Telephone # Dates of Employment (from-to) Pay / Salary Your last Job Title Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements, and/or promotions while you worked at this company. Employer #5 Employer Name Address Supervisor's Name Telephone # Dates of Employment (from-to) Pay / Salary Your last Job Title Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements, and/or promotions while you worked at this company. May we contact your present employer? YesNo QUALIFICATIONS Are you a Journeyman? YesNo Please list Certifications that you currently hold: Certification: Expiration Date: Certification: Expiration Date: Certification: Expiration Date: Certification: Expiration Date: Certification: Expiration Date: How much Experience do you have as a: Millwright? Years: Months: Welder? Years: Months: Laborer? Years: Months: Ironworker? Years: Months: Who have you worked for in Construction? Name: Dates (from-to): Name: Dates (from-to): Name: Dates (from-to): Name: Dates (from-to): Name: Dates (from-to): Please check the boxes of Computer Programs that you are proficient in: Project Microsoft Word AutoCAD EXCEL MINIMUM TOOL LIST Please check the boxes of the tools below that you currently have. (*Minimum Laborers must have) Hardhat- furnished by Phillips & Koch Safety Glasses- furnished by Phillips & Koch * Coveralls * Boots- steel toes * Gloves * Tape Measure * Email Address * Phone with VoiceMail Welding Hood Cutting Goggles Leathers for Welding Slag Hammer Framing Square Pry Bar Tri-Square Tool Belt, Nail Apron, or Bolt Bags Striker Bevel Square 5 Locks & 5 Lock Out Tags 2' or 4' Levels Flashlight Punches Pliers * Crescent Wenches Notepad and Pencil Wrenches to 1 ¼" Torpedo Level Assorted Clamps Sockets to 1 ¼" (Hex) Allen Wrenches Soapstone or Marker Chalk Line Vise Grips JOB APPLICANT SKILL LEVEL SELF-EVALUATION FORM Please mark your level of skill for each of the items below. Project Management ExcellentGoodFairPoor Supervision Skills ExcellentGoodFairPoor Estimating ExcellentGoodFairPoor Carpentry ExcellentGoodFairPoor Concrete ExcellentGoodFairPoor Welding ExcellentGoodFairPoor Pipe Welding ExcellentGoodFairPoor Pipe Fitting ExcellentGoodFairPoor Cutting Torch ExcellentGoodFairPoor Millwright ExcellentGoodFairPoor Ironworker ExcellentGoodFairPoor Operator-Crane ExcellentGoodFairPoor Operator-Forklift ExcellentGoodFairPoor Operator-Man-lift ExcellentGoodFairPoor Reach Forklift ExcellentGoodFairPoor Precision Alignment ExcellentGoodFairPoor Laser – Level – Transit ExcellentGoodFairPoor Blueprint Reading ExcellentGoodFairPoor Punctuality ExcellentGoodFairPoor Attendance ExcellentGoodFairPoor Dependability ExcellentGoodFairPoor Productivity ExcellentGoodFairPoor Work Quality ExcellentGoodFairPoor Safety Training ExcellentGoodFairPoor Computer Skills ExcellentGoodFairPoor Communication Skills ExcellentGoodFairPoor Work Well With Others ExcellentGoodFairPoor SIGNATURE By typing your name into the "Electronic Signature" text field and clicking "Confirm Signature", you are certifying that all information provided to Phillips & Koch Construction, Inc. is true and accurate. Electronic Signature: Confirm Signature: Submit Application
