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H.M. MILLER CONSTRUCTION CO. | Pre-Employment Questionnaire
APPLICATION FOR EMPLOYMENT | Equal Opportunity Employer

Phone: 330-628-4811 | Fax: 330-628-3406 • 1225 Waterloo Road, PO Box 131, Mogadore, OH 44260

- OPTIONS FOR SENDING JOB APPLICATION -

1.) Print Blank to Complete In Pen
2.) Fill Out Below & Print to Send or Bring In
3.)Submit Online (Can Also Print or Save a Copy Before Sending)

-More Instructions For Sending Online & Printing At Bottom of Application-

- - - MUST ALSO PRINT & SIGN AN MVR FORM & EITHER SCAN/EMAIL, FAX, MAIL or BRING IN - - -

PERSONAL INFORMATION
EMPLOYMENT DESIRED

Yes

No

Yes

No

EDUCATION HISTORY
 
Name & Location of School
Years Attended
Did You Graduate

EXPERIENCE INFORMATION

Yes

No

Yes

No

Yes

No

Yes

No

FORMER EMPLOYERS

FROM

TO

NAME & ADDRESS OF EMPLOYER

SALARY

POSITION

REASON FOR LEAVING

*

*

*

*

*

*

REFERENECES
NAME
PHONE NUMBER
EMPLOYER
YEARS KNOWN

*

*

*

*

- APPLICATION NOT VALID WITHOUT SIGNED MVR FORM -
MVR FORM IS AVAILABLE ONLINE AT OUR WEBSITE (MUST EMAIL, FAX, MAIL or BRING IN) -

AUTHORIZATION

*

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 shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal, or otherwise, and release the company from all liability for any damage that may result from utilization from such information. I also understand and agree that no representative 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, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

- Online Job Application - PRINTING & SENDING OPTIONS -

- NOT VALID WITHOUT SIGNED MVR FORM -

MUST PRINT & SIGN AN MVR FORM THEN SCAN/EMAIL, FAX, MAIL or BRING IN

1. - Print or Save This Application - filled out above first or print blank to complete later. You can print and save a copy before submitting online or you may email, fax, mail or bring in.

Jobs@HMMillerCC.com

Fax: 330-628-3406

H.M. MILLER CONSTRUCTION CO.
1225 Waterloo Road, PO Box 131
Mogadore, OH 44260

2. - Send Now - print first if you want a hard copy, then Send Below after printing.

Send A Copy To Your Email Also: (not required)

- Your email and contact information will not be shared with any other parties. -

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