First & Last Name Address Phone Number Position Project Engineer Project Manager Project Superintendent Project Assistant Laborer Available start date Please enter a date in this format DD/MM/YY Desired Pay Range Are you currently employed? Yes No How did you hear about our company? If you are eligible, are you interested in health insurance? Yes No EDUCATION/ACHIEVEMENTS Please enter your education details Emergency Contact Name Emergency Contact Phone Number Employment History Please enter your employment history in the section below. 1. Reference Name Phone Number 2. Reference Name Phone Number 3. Reference Name Phone Number Due to the fact that we work at high security projects, we do require that a full background check is completed. Do you have any conviction that we should be aware of that may affect your eligibility to work on such projects? No Yes If yes, please enter a short description: I hereby certify that the information contained in this application form is true and correct to the best of my knowledge and agree to have any of the statements checked by Far West Contractors Corp unless I have indicated to the contrary. I authorize the references listed above to provide Far West Contractors Corp any and all information concerning my previous employment and any pertinent information that they may have. I understand that any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive an offer, or I am hired, in my dismissal from employment. Upon signing my name, I attest that I am being hired as a free will employee. Applicant's Full Name Date MM/DD/YY
