Application - E&T Contracting

Job Application

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Are you over 18 years of age:*
- Yes
- No
Sex:*
- Male
- Female
Driver's License No.
Driver's License State
Driver's License Expiration Date
Month
Day
Year
Position Desired*
Date you can begin work:*
MM slash DD slash YYYY
Are you currently employed:*
- Yes
- No
If so, may we contact your employer?*
- Yes
- No
List your past three (3) employers, beginning with most recent:
Company Address Phone Supervisor
List your past three (3) schools you attended, beginning with most recent:
Name Years Completed Did You Graduate? Major/Degree
List three (3) references and their contact information:*
Name Phone Number Relationship To This Person
Construction Experience*
List any and all experience you have in the construction industry. Please be specific.
Pre-Employment Drug Testing Consent*
I hereby consent to submit to urinalysis and/or other tests as shall be determined by E & T Contracting in the selection process of applicants for employment, for the purpose of determining the drug content thereof.

I agree that WorkPlace Solutions/621 Old Hickory Blvd. Ste G, Jackson, TN may collect these specimens for these tests and may test them or forward them to a certified testing laboratory designated by the company for analysis.
I further agree to and hereby authorize the release of the results of said tests to E & T Contracting and their MRO (Medical Review Officer).

I further agree to hold harmless the said laboratory and MRO and its agents from any liability arising in whole or part out of the collection of specimens for testing.

I have carefully read the foregoing and fully understand the contents. I acknowledge that my signing of this consent and release form is a voluntary act on my part and that I have not been coerced into signing this document.

I agree.
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application will be grounds for dismissal.*
I agree.
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Job Application

Our Company

Contact Details

Company	Address	Phone	Supervisor

Name	Years Completed	Did You Graduate?	Major/Degree

Name	Phone Number	Relationship To This Person