Job Application - H.M. Miller Construction Co.

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-

- To Be Considered For Hire -

YOU MUST ALSO PRINT & SIGN THIS MVR FORM & EITHER SCAN/EMAIL, FAX, MAIL or BRING IN.

- - - IMPORTANT! - - -
When filling out this application, EVERY Input Area/Box, that is labeled Required, MUST be filled in (every box with a Red Star) If wanting to leave a required box empty, type 'NA'

= Required

PERSONAL INFORMATION

FULL NAME:

DATE:

ADDRESS:

CITY:

STATE:

ZIP CODE:

HOME PHONE:

CELL PHONE:

REFERRED BY:

EMPLOYMENT DESIRED

POSITION:

DATE YOU CAN START:

SALARY DESIRED:

ARE YOU EMPLOYED?:

Yes

IF SO, MAY WE INQUIRE OF YOUR PRESENT EMPLOYER?:

Yes

EDUCATION HISTORY

Name & Location of School

Years Attended

Did You Graduate

HIGHSCHOOL

COLLEGE

TRADE SCHOOL

EXPERIENCE INFORMATION

EVER HAD DOMINION EXPERIENCE?

Yes

IF YES, ARE THEY CURRENT?

Yes

DO YOU HAVE A CDL?

Yes

IF YES, IS IT CURRENT?

Yes

FORMER EMPLOYERS

FROM

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

TypeWrite Your initials On the Line Below to Agree to Our Application Terms

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)

Type Email:

Confirm Email:

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

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Send To HM Miller (and your email if you typed it above)