Employment Application – Keystone Civil

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Application Received
Thank you for your interest in Keystone Civil.

1. Applicant Information

Last Name

First Name

Middle Initial

Street Address

Apartment / Unit No.

City

State

Zip Code

Phone

Email Address

Date of Birth

Social Security No.

Driver’s License

Position Applying For

Desired Salary

Date Available

Are you a citizen of the United States? Yes No

Are you authorized to work in the United States? Yes No

Have you ever worked for Keystone Civil? Yes No

When did you work for Keystone Civil?

2. Education

High School Name

Location

Degree Earned

Date From

Date To

Did you graduate high school? Yes No

College Name

Location

Degree Earned

Date From

Date To

Did you graduate college? Yes No

Other School Name

Location

Degree Earned

Date From

Date To

Did you graduate? Yes No

3. Licenses & Certifications

Please provide details for any industry-related licenses or certifications you possess...

Name of License or Certification

Licensing Agency

ID Number

Date Received

Expiration Date

4. Job Related Training & Coursework

Name of School

Location

Course of Study

Date From

Date To

Did you complete your training? Yes No

Name of School

Location

Course of Study

Date From

Date To

Did you complete your training? Yes No

Name of School

Location

Course of Study

Date From

Date To

Did you complete your training? Yes No

Name of School

Location

Course of Study

Date From

Date To

Did you complete your training? Yes No

5. Professional References

Full Name

Company Name

Relationship

Address

Phone

Full Name

Company Name

Relationship

Address

Phone

Full Name

Company Name

Relationship

Address

Phone

6. Employment History

Company Name

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

Date From

Date To

Reason For Leaving

May we contact your previous supervisor for a reference? Yes No

Company Name

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

Date From

Date To

Reason For Leaving

May we contact your previous supervisor for a reference? Yes No

Company Name

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

Date From

Date To

Reason For Leaving

May we contact your previous supervisor for a reference? Yes No

7. Computer Skills

Please describe any job-related computer/software skills you possess...

8. Military Service

Have you ever served in the United States Military? Yes No

Military Branch

Date From

Date To

Rank at Discharge

Type of Discharge

If discharge was other than honorable, please explain...

9. Background Information

Please note: Answering “Yes” to any of these questions will not automatically bar you from employment. The nature, job‐relatedness, severity and date of the offense in relation to the position for which you are applying will be considered.

Have you ever been convicted of a felony or misdemeanor? Yes No

What were the charges against you?

Location

Date

Have you ever pled nolo contendere or pled guilty to a crime which is a felony or misdemeanor? Yes No

What were the charges against you?

Location

Date

Have you ever had the adjudication of guilt withheld for a crime which is a felony or misdemeanor? Yes No

What were the charges against you?

Location

Date

10. Resumé

Please attach your resumé in PDF format, if available. Maximum upload file size is 2 MB

11. Disclaimer, Consent & Signature

I am aware that any omissions, falsifications, misstatements, or misrepresentations above may disqualify me for employment consideration and, if I am hired, may be grounds for termination at a later date. I understand that any information I give may be investigated as allowed by law. I consent to the release of information about my ability, employment history, and fitness for employment by employers, schools, law enforcement agencies, and other individuals and organizations to investigators, personnel staff, and other authorized employees or agents for employment purposes. This consent shall continue to be effective during my employment if I am hired. I certify that to the best of my knowledge and belief all of the statements contained herein and on any attachments are true, correct, complete, and made in good faith.

I have read and agree to the application terms outlined above

Enter your full name to sign this application

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