First Name:                    Last Name:                    M.I.:

Street Address:                   

Apartment/ Unit #: City:                    State:                    ZIP Code:                  

Phone:                   E-mail Address:

Social Security #: Driver's License #: State:

Date Available:                  Desired Salary:                  Position Applied for:                 

Are you a citizen of the United States? Yes No

Have you ever worked for this company? Yes No If so, when?

Are you related to any current Endeavor Board Member? Yes No
(Click here to view the current Endeavor Board Members.)

Have you ever been convicted of a felony? Yes No

If yes, explain:

Are there any other job related experiences, skills, or qualifications which will be of special benefit in the job for which you are applying?

Are you available to work extended days and/or hours on a regular basis? Yes No

Do you have any physical limitations that would prevent you from digging with a shovel for extended periods of time, lifting a minimum of 60 lbs., or walking several miles per day? Yes No

Do you have experience with heavy equipment? Yes No

If yes, what type?

Do you have a valid Indiana Driver's License? Yes No

Do you have a valid Indiana Commercial Driver's License (CDL)? Yes No

If yes, which Class? Class A Class B

Which CDL endorsements do you possess? Air Brakes Tankers (check all that apply)

High School: Address:

From: (years) To: Did you graduate? Yes No Degree:

College: Address:

From: (years) To: Did you graduate? Yes No Degree:

Other: Address:

From: (years) To: Did you graduate? Yes No Degree:

Full Name: Relationship:

Company: Phone:

Address:

Full Name: Relationship:

Company: Phone:

Address:

Full Name: Relationship:

Company: Phone:

Address:

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary: Ending Salary:

Responsibilities:

From: To: Reason for leaving:

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

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary: Ending Salary:

Responsibilities:

From: To: Reason for leaving:

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

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary: Ending Salary:

Responsibilities:

From: To: Reason for leaving:

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

Branch: From: To:

Rank at Discharge: Type of Discharge:

If other than honorable, explain:

Disclaimer

The facts set forth in my application for employment are true and complete. I understand that if employed, any false statement given in my application or interview(s) may result in my dismissal. I also understand that prospective employees may be asked to satisfactorily complete or submit to a drug/alcohol screening or background check. I further understand that this application is not and is not intended to be a contract of employment, nor does this application obligate the employer in any way if the employer decides to employ me. I understand and agree that my employment is at-will and can be terminated by either party with or without notice, at any time, for any reason or no reason. No one other than an officer of the Company has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing and then only in a writing signed by an officer. .

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