Previous Addresses (provide 3 years):
In compliance with Federal and State equal opportunity laws, qualified applicants are considered for all positions without regard to
race, color, religion, sex, national origin, age, marital status, veteran status, non-job-related disability, or any other protected group
To be read and signed by applicant
I authorize you to make such investigations and inquires of my personal, employment, financial or medical history and other related
matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only
if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers, and
other persons from all liability in responding to inquiries and releasing information in connection with my application.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in
discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.
I understand that Terry R. Pitt Construction, Inc. has a Drug Alcohol and Substance Use/Abuse policy and that any offered
employment is conditional upon successful passing of a drug screening test.
I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be
contacted, for the purpose of investigating my safety performance history. I understand that I have the right to:
Review information provided by previous employers.
Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected
information to the prospective employer; and
Have a rebuttal statement attached to the erroneous information, if the previous employer(s) and I cannot agree on the
accuracy of the information.
Lastly, I certify that this application was completed by me, and that all entries on it and information in it are true and complete to
the best of my knowledge.
Driver’s License Information: List all licenses held within the previous 3 years.
Please give accurate full time and part time employment records. Start with your current or most recent employer
Business or Personal References
Experience and Qualifications