Lindberg aggregates, road construction, drilling, blasting, airport construction, bridge construction

Application For Employment (At-Will)

A. Lindberg & Sons, Inc.
560 Mather Ave.
Ishpeming, MI 49849

Phone: 906-486-4459
Fax: 906-486-6550
Email: lindberg@lindberginc.com

To the Applicant: We appreciate your interest in our Firm and assure you that we are interested in your qualifications. A clear understanding of your background and work history will aid us in seeking to place you in a position which, in our judgment, best meets your qualifications.

We are an equal opportunity employer and will not discriminate against any applicant on the basis of any characteristic that is protected by State or Federal law. Michigan law requires that a person with a disability or handicap requiring accommodation to perform the essential duties of the job must notify the employer in writing within 182 calendar days of the date that the need is known or should have been known.

It is the policy of A. Lindberg & Sons Inc. that every employee is entitled to work under the safest possible conditions in the construction industry. Therefore, Applicants being considered for employment will be subject to pre-employment screening for drugs and/or alcohol. A positive result from such screening tests shall be grounds for denying or revoking employment to the applicant.

Position Applied For:

Date of Application:

Date You Can Start:

Please note that this application will only remain active for 3 months, after which the applicant would need to re-apply.

Name:
Name:	Last	First	MI

SSN:

Present Address:
Present Address:	Street	City	State	Zip

Permanent Address:
Permanent Address:	Street	City	State	Zip

Telephone #:
Telephone #:	Home	Work

Are you 18 years or older?

Yes

Are there any hours or days of the week you cannot work?

If so, when?

Salary Desired: $

Type of Employment:
Full-time Part-time

Are you employed now? YesNo

May we contact your present employer? YesNo

Name, title and phone of current employer:

Have you ever applied to this Company before? YesNo

Where?

Under what name?

When?

Have you been previously employed here?YesNo

If yes, date(s):

Supervisor Name(s):

List any friends or relatives working here:

What method of transportation will you use to come to work:

EDUCATION:

	Name and Location of School	No. of Years Attended	Did You Graduate?	Subject/Major
Elementary School
High School
College
Specialized Training


Do you have US Military experience?YesNo		Date Entered:
Branch:	Rank:	Date Discharged:	Honorably?
Are you in the reserves?YesNo		If yes,date obligation ends:
Special/technical training:
Are you lawfully entitled to be employed in the United States?YesNo
Have you ever been convicted of a crime except a minor traffic violation?YesNo
If so, please state citation, date and place where offense occurred.
Please provide any additional information such as special skills, training, management experience, equipment operation or qualifications you feel will be helpful to us in considering your application.
Union Affiliation, if any:
Do you have a valid driver's license? YesNo		CDL License?YesNo
License No.		State
List professional trade, business or civic activities and offices held excluding groups the name or character of which indicate race, color, religion, sex, national origin, handicap, marital or veteran status, height, weight or age:

REFERENCES:
Three individuals not related to you, whom you have known for at least one year:

Name	Address and Telephone	Relationship	Years Acquainted

Emergency Contact:
Emergency Contact:	Name	Street	City/State	Phone

CURRENT AND FORMER EMPLOYERS: (Most Recent First)

Date Month/Year

Employer Name, Address, and Telephone

Salary Starting/ Ending

Last Position Held/ Responsibilities

Reason for Leaving

From:

To:

From:

To:

From:

To:

From:

To:

From:

To:

May we contact the employers listed?		Yes	No
If not, which one(s)?

* * *

Please read the following statement carefully before signing to indicate your understanding.

I certify that the facts contained in this application are true, accurate, and complete to the best of my knowledge and understand that, if employed, falsified statements or omitted material facts on this application may result in my disqualification from consideration for employment, or termination from employment if I have been hired.

I authorize you to verify any of the information concerning my background, including but not limited to, my employment, driving record, education, criminal history, medical history (post-offer only), or credit history report, with the appropriate individuals, companies, institutions or agencies, and I authorize them to release such information as you require, including my prior disciplinary employment record, without any obligation to give me written notice of such disclosure. I also authorize you to release any information requested by any of my prospective or subsequent employers without any obligation to give me written notice of such disclosure. I hereby release you and them from any liability whatsoever as a result of any such inquiries and disclosures and this release from liability does not waive or prohibit an individual from filing a charge of discrimination under the laws enforced by the EEOC.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated with or without cause, at any time, with or without notice. This provision supersedes any oral or written representation to the contrary unless in writing and signed by both the President of the company and the person to whom the writing is directed. I hereby understand that construction work is seasonal, and therefore, if hired, my employment will most likely be terminated at the seasons end or upon completion of the project for which I was hired.

I agree that I shall be bound by the other rules, policies, regulations and terms and conditions of employment of the firm as they are from time to time changed, and no additional obligations can be imposed on the firm except those which have been acknowledged in writing, by the president or his designated representatives.

I agree that any action or suit against the firm, its agents or employees, arising out of my employment or termination of employment, including, but not limited to, claims arising under State and Federal law, but not Federal civil rights statutes containing a separate limitations period, must be brought within 180 days of the event giving rise to the claims or be forever barred unless the applicable statute of limitations period is shorter than 180 days in which case I will continue to be bound by that shorter limitations period. I waive any limitation periods to the contrary. I further agree that if I should bring any non-statutory action or claim arising out of my employment against the firm, in which the firm prevails, I will pay to the firm any and all such costs incurred by the firm in defense of said claims or actions, including attorney fees..

Signature	Date:
Type Name Here