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Application for Employment

Burkhardt Construction is always accepting applications to join our team. For specific information on whether or not we are hiring certain positions, please email sarah@burkhardtconstruction.com.

Transparency in Coverage Act

United Healthcare creates and publishes the Machine-Readable Files on behalf of Burkhardt Construction, Inc. They can be accessed at https://transparency-in-coverage.uhc.com/

Application for Employment

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PERSONAL INFORMATION

*Date of Application

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NAME OF APPLICANT

*Last Name

*First Name

Middle Name

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HOME ADDRESS

*Street

*City

*State

*Zip

*Phone Number

*Date of Birth

*Email

*Are you authorized to work in the U.S.A.?

Yes

*Are you related to any to any of our employees?

Yes

If 'yes', please state his/her name.

Name of the person who referred you.

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EMPLOYEMENT DESIRED

*Position you are applying for

*Date you can start if hired

*Rate of pay desired

*Are you employed now?

Yes

If 'yes', may we inquire of your present employer?

Yes

*Have you ever applied for employment to this company before?

Yes

If 'yes', please state where and when

*Are you willing to travel to 'out of town' job sites?

Yes

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EDUCATION

Please list any relevant educational background.

*Check the types of vehicle you are qualified to operate

If you checked 'other', please clarify/name the vehicle type

Please name the subjects of any special study or research work done by you

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FORMER EMPLOYERS

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LIST BELOW THE LAST FOUR EMPLOYERS STARTING WITH THE MOST RECENT ONE FIRST

A. Employed From

Employed To

Name, address and phone number of employer 'A'

Salary and duties at employer 'A' & reasons for leaving

B. Employed From

Employed To

Name, address and phone number of employer 'B'

Salary and duties at employer 'B' & reasons for leaving

C. Employed From

Employed To

Name, address and phone number of employer 'C'

Salary and duties at employer 'C' & reasons for leaving

D. Employed From

Employed To

Name, address and phone number of employer 'D'

Salary and duties at employer 'D' & reasons for leaving

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REFERENCES

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GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU WHOM YOU HAVE KNOWN AT LEAST ONE YEAR

Name 1

Years Acquainted 1

Address 1

Business 1

Name 2

Years Acquainted 2

Address 2

Business 2

Name 3

Years Acquainted 3

Address 3

Business 3

All of the above references may be checked/contacted.

Yes

If 'no', give the names of the references that can be checked/contacted

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PHYSICAL CONDITION

*Are you able to perform the specific duties of the job you are applying for?

Yes

*Do you have any physical limitations that would prevent you from performing the job you are applying for?

Yes

If 'yes', please give details of any physical limitations that would prevent you from performing the job you are applying for.

*Do you require any physical/equipment modifications to accomplish the job you are applying for?

Yes

If 'yes', please explain the requirements of physical/equipment modifications to accomplish the job you are applying for.

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FELONY CHARGES

*Have you ever been convicted of a felony?

Yes

If 'yes', give details.

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EMERGENCY CONTACT

*Name of person to be contacted in case of an emergency

*Relationship to the person to be contacted in an emergency

*Phone number of person to be contacted in an emergency

*Address of person to be contacted in an emergency

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AUTHORIZATION OF RELEASE OF INFORMATION

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Applicant represents that all of the above information and statements on the application are true and complete, and hereby authorizes an investigative report including, but not limited to, residential history, employment history, criminal records history, court records, credit records and driving records. This application must be signed before it can be processed. Applicant acknowledges that false or omitted information herein may constitute grounds for rejection of this application and termination of employment, and may constitute a criminal offense under the laws of this state. If accepted for employment, I will comply with all rules and safety regulations of my employer and the department to which I am assigned. I acknowledge that, if hired, there is no guarantee of full-time work.

*By clicking the "I AGREE" button, this application is deemed to have been SIGNED by you. This application will be deemed to be NOT SIGNED by you, if "I DO NOT AGREE" button is selected

I AGREE

I DO NOT AGREE