Position Applying For:

Grading Supervisor

Operating Engineer

Utility Pipe Layer

Utility Supervisor

Utility Top Laborer

Personal Information

Name(Required)

First Last

Email(Required)

Mobile Phone(Required)

Home Phone

Today's Date

Home Address(Required)

Street Address City State ZIP Code

Union Affiliation

Operating Eng. Local 139

Laborers Local 113

Milwaukee Area Truck Drivers

None

Other Union

Other

Are You Employed Now?

Yes

May We Contact Your Current Employer?

Yes

Have You Worked for Edgerton Before?

Yes

Have You Applied for Work with Edgerton Before?

Yes

Do You Have A Driver's License That Is Valid In Wisconsin?

Yes

If yes, please provide Wisconsin Driver's License Number

CDL

Yes

List Endorsements

Can You Provide Your Own Transportation to Work?

Yes

Date Available

Who Referred You?

Education/Employment Experience

Highest Grade Completed

Grade School

High School

College/Technical School

Equipment Operating Experience/Special Training/Construction Experience

Former Employers

Employer 1

Dates Worked From-To

Name and Address of Employer

Wages

Position

Reason for Leaving

Employer 2

Dates Worked From-To

Name and Address of Employer

Wages

Position

Reason for Leaving

Employer 3

Dates Worked From-To

Name and Address of Employer

Wages

Position

Reason for Leaving

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The following information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect any consideration you may receive for employment. Government agencies require periodic reports on sex and ethnicity of applicants.

This data is for analysis and affirmative action only.

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Government contractors are subject to Section 402 of the Vietnam Era Veterans Readjustment Act of 1974 which requires that they take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and other eligible veterans, and Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals, and the Jobs for Veterans Act.

If you are a special disabled veteran, a Vietnam Era Veteran, recently discharged veteran or other protected veteran, or have a physical or mental handicap, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job in a proper and safe-manner.

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Application for Employment

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Education/Employment Experience

Former Employers

Employer 1

Employer 2

Employer 3

Affirmative Action Survey

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