Black Horse Construction, Inc.
Application for Employment
PERSONAL INFORMATION
Do you have a:
Valid drivers license: Yes___ No___ Soc. Security card, passport, or certified birth cert.: Y___ N___
Clean driving record the past 3 years: Y___ N___ Current medical card (if a CDL driver): Y___ N___
If you answered no to any of these questions: STOP, do not complete or submit this application.
Name Date
Present Address
City State Zip
Permanent Address
City State Zip
Phone Number Are you 18 years or older? Yes No
E-Mail Address
Employment Desired
Date you Salary
Position can start? Desired
If so may we inquire
Are you Employed now? of your present employer?
Ever applied to this company before? Where? When?
Referred by
Education
# of years Did you Subjects
Name & Location attended graduate studied
High School
College
Trade or
Business School
General
Please indicate the number of years of experience you have either directly or indirectly, including
High School:
Mechanics Oil Heavy Spanish Speak
(auto or other) Field equipment Write
Welding Pipe Fitting CDL Supervision
Other trades or activities
US Military Present membership
or Naval Service Rank in National Guard or Reserves
PO Box 996, Stanley, ND 58784
BUS: 701-628-3047 FAX: 701-628-3049 EMAIL: info@blackhorseconstruction.org
Black Horse Construction, Inc.
Application for Employment
Former Employers (List below last three employers starting with last one first)
Date Name and Address
Month & Year of Employer Salary Position Reason for leaving
From
To
From
To
From
To
From
To
Which job did you like best and why?
References
Give the names of three persons not related to you, whom you have known at least one year
# years
Name Address Phone Number Business known
Primary Contact for Emergencies:
Name Address Phone No.
Relationship
Secondary Contact
Name Address Phone No.
Relationship
"I certify that all the information submitted by me on this application is true and complete, and I
understand that if any false information, omissions, or misrepresentations are discovered, my
application may be rejected and, if I am employed, my employment may be termintated at any time.
DATE: SIGNATURE: