Application for Employment

First Name: MI Last Name: Social Security #:

Date of Birth: Email Address:

Home Address: City: State: Zip:

Home Phone: Cell Phone: Other:

Are you seeking full-time employment? Yes No	Have you ever applied to Bull Dredging before? Yes No
Do you mind working nights, weekends, or holidays? Yes No	Do you know how to swim? Yes No

Please describe any special training or skills you can offer Bull Dredging.

Employment History:

Please complete regardless of resume, beginning with the most recent/current employer. Bull Dredging reserves the right to contact each employer listed below unless otherwise noted:

DATE		EMPLOYER'S NAME, ADDRESS, & PHONE	SALARY	POSITION	REASON FOR LEAVING	CONTACT?
MTH	YEAR

						Yes No


						Yes No


						Yes No

Education:

Please check all that apply.

High School

I did not finish my schooling. Years completed.

General Education - Diploma or equivalent

Trade School - Years completed

College - Years completed

Additional Information:

Do you have any pre-existing medical conditions that Bull Dredging should be aware of? Yes No

If yes, please describe.

Do you have any physical handicaps, which prevent you from performing certain jobs or tasks? Yes No

If yes, please describe.

Have you ever received Workmen's Compensation of disability income payments? Yes No

If yes, please describe.

Have you ever been convicted of a felony? Yes No

If yes, please describe.

Are you currently on any type of probation and/or any court order restrictions? Yes No

If yes, please describe.

The information requested below is for a legally permissible reason, including, without limitation, legitimate occupational qualification or business necessity. Federal law prohibits discrimination based upon ancestry, marital status, or physical or mental handicap.

Sex?

Male

Female

Marital Status?

Single

Married

Separated

Divorce

Applicant's Acknowledgement:

I hereby declare that the information I have provided herein is correct and complete to the best of my knowledge. I authorize Bull Dredging and/or is represenative to contact previous employers, except otherwise noted, for references and verification of statements made. I understand that pre-employment questionnaire is not a contract of employment. I understand that if employed, any false or misleading information given in this questionnaire or in my interview(s) shall be ground for disciplinary action, including termination. I understand that Bull Dredging offers equal opportunity treatment to all employees and qualified applicants. Employment relies on the consent of both the company and myself. It can be terminated by either party at anytime.

Full Name: