Were you referred by someone? If so, who?

First Name

Last Name

Have you ever worked at Lakeside before?

Yes

No

Name *

First Name

Last Name

Today's date *

MM

DD

YYYY

Date of birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary phone *

(###)

###

####

Secondary phone

(###)

###

####

Emergency contact person *

First Name

Last Name

Emergency contact phone *

(###)

###

####

Primary Language *

English

Spanish

Other

If English is not your primary language, can you speak & understand it? *

Yes

No

Do you have any physical limitations or pre-existing conditions that prevent you from being a construction laborer? *

Yes

No

Are you capable of lifting up to 50 lbs? *

Yes

No

Do you have any physical or functional limitations (like asthma, respiratory issues, fear of heights, etc.) which might prevent you from being able to perform highly physical and difficult construction labor? *

Yes

No

Are you at least 18 years old? *

Yes

No

Are you eligible to be lawfully employed in the United States? *

Yes

No

Do you have a valid driver’s license? (check all that apply)

Class A

Class B

CDL

Class C

Within the last 5 years, have you had any license to operate any motor vehicle suspended or revoked by any authority for any reason? *

Yes

No

Do you have a means of transportation to our work site(s)? *

Yes

No

How far are you willing to travel? (check one) *

Travel to construction projects as well as routine overtime and Saturday work are common. You must be willing to travel when and where assigned and be available to work hours as determined by Lakeside Concrete Cutting Inc. The company provides travel expenses and motel accommodations when employees are required to travel specified distances and stay away from home.

Not willing to travel

Up to 50 miles

Up to 100 miles

Willing to travel to any assignment

Are you willing to stay overnight at a motel room when assigned to certain far-away projects (for example, Portland, Calais or Presque Isle)? *

Yes

No

Are you willing to: begin work at 5AM, work 12 hour days, work nights, work Saturdays, or work Sundays if and when required, sometimes with short or little notice? *

Yes

No

Do you have any experience using hand held saws? *

Yes

No

Have you ever been a mechanic/have any mechanical experience? *

Yes

No

What is the earliest date you are available to start working? *

MM

DD

YYYY

Do you now, or have you ever been required to register as a sex offender? *

Yes

No

Have you been disciplined (orally or in writing) by any previous employer or supervisor? *

Yes

No

Have you been discharged from a place of employment? *

Yes

No

Have you been asked to resign from a place of employment? *

Yes

No

Have you ever had any professional license suspended or revoked? *

Yes

No

Please check below all vehicles or equipment with which you have experience

Skid Steer

Forklift (rough terrain)

Chain Saw

Impulse Hammer

Forklift (warehouse)

Skill Saw

Loader

Grader

Table Saw

Dump Truck

Roller

Gas Demo Saw

Backhoe

Excavator

SawZall

Bulldozer

Boom Truck

Hammer Drill

Crane

Pulp Truck

Concrete Saw

Skidder

Wood Splitter

Core Drill

Asbestos

Lead

Mold

Hazardous Materials

Have you ever acted as a supervisor to another person or supervised a crew? *

Yes

No

Have you completed any of the following training courses: (check any you have completed)

OSHA 10 HOUR

OSHA 30 HOUR

OSHA 40 HOUR Hazwopper

Confined Space Training

Competent Person Excavation Training

Utility Trench Excavation Training

Certified Signal Person Training

Qualified Rigger Training

Fork Truck Operator Training

Do you have experience welding? *

Yes

No

Do you have any of the following welding qualifications? (check any which apply)

F.C.A.W.

G.M.A.W.

G.T.A.W.

S.M.A.W.

Field Welding Techniques

Purging

Cut with Oxygen/Acetylene Torches

Use Backing (Fiberglass/Ceramic)

Date of graduation

MM

DD

YYYY

Date of graduation

MM

DD

YYYY

Date of graduation

MM

DD

YYYY