Present Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Permanent Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mobile Phone *

(###)

###

####

Other/Secondary Phone

(###)

###

####

If hired, can you furnish proof that you are 18 years of age or older and eligible to work in the United States? *

Yes

No

Have you applied for work or worked at our company before? *

Yes

No

Are you able to work at anytime of the day or week as needed? *

Yes

No

Date Available to Start *

MM

DD

YYYY

Do you have a current, valid and unrestricted driver's license(s)? *

Yes

No

Have you received DWI, DUI, or other driving violations within the last two years? *

Yes

No

Are you acquainted with anyone who is or was employed by our Company?

Yes

No

Employer's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer's Telephone Number

(###)

###

####

Full Time or Part Time

Full Time

Part Time

Supervisor's Name

First Name

Last Name

Dates of Employment

From

MM

DD

YYYY

To

MM

DD

YYYY

Employer's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer's Telephone Number

(###)

###

####

Full Time or Part Time

Full Time

Part Time

Supervisor's Name

First Name

Last Name

Dates of Employment

From

MM

DD

YYYY

To

MM

DD

YYYY

Employer's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer's Telephone Number

(###)

###

####

Full Time or Part Time

Full Time

Part Time

Supervisor's Name

First Name

Last Name

Dates of Employment

From

MM

DD

YYYY

To

MM

DD

YYYY

Employer's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer's Telephone Number

(###)

###

####

Full Time or Part Time

Full Time

Part Time

Supervisor's Name

First Name

Last Name

Dates of Employment

From

MM

DD

YYYY

To

MM

DD

YYYY

Have you ever been laid off or asked to resign by an employer?

Yes

No

May we contact the employers listed above?

Yes

No

Are you on layoff status and eligible for referral for hire by a hiring hall or employment service?

Yes

No

Reference 1

Individual's Name

First Name

Last Name

Reference Telephone Number

(###)

###

####

Reference Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference 2

Individual's Name

First Name

Last Name

Reference Telephone Number

(###)

###

####

Reference Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference 3

Individual's Name

First Name

Last Name

Reference Telephone Number

(###)

###

####

Reference Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Lloyd's Construction Services requires that it's employees be able to work throughout Minnesota and beyond as work requires. Are you prepared to work including overnight stays on occasion, wherever Lloyd's Construction Services may assign you?

Yes

No

Lloyd's Construction Services requires that each employee purchase a specific set of tools as a condition of employment. Each individual employee is responsible for having access to these tools each day, and the employee is responsible for transporting his/her own tools to each project or job site. Are you willing to purchase such tools and do you have a valid drivers license and access to a vehicle sufficient to transport tools to and between job sites on a daily basis?

Yes

No

Do you plan to work for any other employer or engage in self employment during your period of employment with Lloyd's Construction Services?

Yes

No

Are there any employer policies, requirements, terms or conditions of employment or types of work which you are unwilling to accept if you are offered employment?

Yes

No

Have you ever worked in our industry at any time not listed above?

Yes

No

You may be asked to provide a medical history, submit to a drug and/or alcohol test and/or physical/medical examination if you are made a conditional offer of employment. Are you willing to do so?

Yes

No

Lloyd's Construction Services has polices on sexual harassment and equal employment opportunity, policies which require employees to perform all assigned work and mandatory overtime, policies requiring wage and salary deduction authorizations by employees for employee property, debts or monies not returned or repaid, an at-will employment policy, solicitation and distribution policies and policies requiring employees to observe all standards of conduct, policies and work rules of Lloyd's Construction Services and for certain employees, confidentiality, non-solicitation and/or non-competition agreement requirements. Do you agree, if hired to comply with these and all other current or subsequently adopted Lloyd's Construction Services policies and requirements?

Yes

No

By my signature below, I promise that the information provided in this employment application (and any related information provided by me) is true and complete, and I understand that any false or misleading information or significant omission may disqualify me from further consideration for employment, and may lead to my dismissal from employment, if discovered at a later date, no mater how long I have been employed. I authorize Lloyd's Construction Services, Inc. (the Employer) to obtain and/or provide any and all information and opinion which the employer elects to obtain, use or provide in connection with my application for employment and/or any employment with the Employer, prior to, during and after my employment. Such information and opinion may be sought from any and all prior employers(except as noted above), schools or other persons or organizations who may have information the Employer deems relevant in connection with my application for employment and during my employment, and may be provided by the Employer in response to any request for information and opinion concerning my employment or my separation from employment with Employer, to any and all banks or mortgage companies, governmental agencies, insurers, prospective employers or other schools, persons or organizations deemed appropriate for receipt of such information by the Employer, I understand that the Employer may provide any and all information and opinion, which may include, but are not limited to opinions about my conduct, performance, attendance or any other aspect of my reputation or character, which may be positive or negative. I agree to hold the Employer (including its principals, employees, agents, consultants, attorneys and insurers) and any such other employer, school, person or organization providing or receiving any such information and option, harmless and free of any and all claims or causes of action arising from any such provision or receipt of information and opinion no mater what it's character. I UNDERSTAND THAT THIS APPLICATION DOES NOT CREATE A CONTRACT OF EMPLOYMENT. I UNDERSTAND THAT IF I AM HIRED, I AM OBLIGATED TO COMPLY WITH ANY AND ALL CURRENT AND SUBSEQUENTLY ADOPTED LLOYD'S CONSTRUCTION SERVICES, INC. POLICIES AND THAT LLOYD'S CONSTRUCTION SERVICES, INC. DOES NOT OFFER CONTRACTS, PROMISES OR REPRESENTATIONS RELATED TO EMPLOYMENT. I UNDERSTAND AND AGREE THAT IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD OF TIME, AND MAY BE TERMINATED WITHOUT CAUSE, NOTICE OR PRIOR WARNING OR DISCIPLINE. I UNDERSTAND THAT NO PERSON IS AUTHORIZED TO CHANGE ANY OF THE TERMS MENTIONED IN THIS EMPLOYMENT APPLICATION. *

Please type your name as a digital signature

First Name

Last Name

Date *

Please provide todays date

MM

DD

YYYY