William E. Groves Construction 3135 Grapevine Road
PO Box 1205
Madisonville, KY 42431
Phone (270) 825-1437
Fax    (270) 825-1485

We consider applicants for all positions without discrimination because of race, color, religion, sex, national origin, age, disability, or any other legally protected status.

This application must be filled out in its entirety to be considered and will remain active for 6 months, after which the applicant will need to re-apply.
PERSONAL INFORMATION
Position Applied For: Date of Application: 02/3/12

How did you learn about us?

Advertisement   Friend/relative   Temp Service   Walk-in   Other
Social Security #: --   Date of Birth: //

Name

Last:   First:   MI:
Address
Street:
City, State, ZIP:
Telephone: Home () -   Other () -
Have you been convicted of a crime? Yes No
Convicition will not necessarily disqualify you from employment. If yes, please explain:
Can you work on a job that requires you to be out of town all week? Yes No
Have you applied here before? Yes No   If so, when?
EDUCATION
High School Attended City, County & State Did you earn a Diploma?
Undergraduate College
Attended 		City
& State 		Area
of Study 		Degree, Certificate
or Diploma
Graduate College
Attended 		City
& State 		Area
of Study 		Degree, Certificate
or Diploma
Trade, Business or
Other School 		City
& State 		Area
of Study 		Degree, Certificate
or Diploma
JOB-RELATED SKILLS
**ALL APPLICANTS MUST HAVE OR BE ABLE TO OBTAIN IMMEDIATELY, CDL LICENSE AND 24-HOUR SURFACE MINE TRAINING.
Do you have a valid driver's license? Yes No
Do you have a Commercial Driver's License? Yes No Class: A B
If so, do you have air brake endorsements? Yes No
Please list all states from which you hold or have held a driver's license:
Do you have 24 Hour Surface Mine Training? Yes No
Please use this space to list other license, certifications and/or skills you have.  Be sure to include any machinery/equipment you can operate.
Use this space to list any activities and/or hobbies (Civic, Athletic, etc.) which you are involved:
(Exclude organiztions, the name of which indicates the race, creed, sex, age, martial status, color or nation of origin of its memebers)
EMPLOYMENT HISTORY
Start with your present or most recent job and cover you last three jobs.  Include any job-related military service assignments, self-employment, summer and part-time jobs.
1) Company:
Address:
Telephone: () - Supervisor:
Date Employed
From: // To: // 		  Salary
Starting $ Leaving $
Your Duties:
Reason for Leaving:
2) Company:
Address:
Telephone: () - Supervisor:
Date Employed
From: // To: // 		  Salary
Starting $ Leaving $
Your Duties:
Reason for Leaving:
3) Company:
Address:
Telephone: () - Supervisor:
Date Employed
From: // To: // 		  Salary
Starting $ Leaving $
Your Duties:
Reason for Leaving:
If presently employed, why do you desire to change your present position?
If presently employed, may we contact your present employer? Yes No
REFERENCES (not former Employers or Relatives)
Name Telephone () -
Name Telephone () -
Name Telephone () -
ACKNOWLEDGEMENT
****

Please read the following statement carefully before signing to indicate your understanding:

I understand that, if I receive a conditional job offer and prior to beginning employment, I may be requested to undergo a pre-employment medical examination.

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 may result in termination.

I understand and agree that, if hired, my employment is AT-WILL.  THIS MEANS THAT, IF HIRED, EITHER THE COMPANY OR I CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.

I authorize investigation of all statements contained in this application for any employment-related purpose.  I release the listed references an all employers to provide you with any and all applicable information they may have.  I hereby release these references and former employers from all liability for any information they may give to you, including but to limited to any defamation claims I may now have or will have against them.
Friday 3rd of February 2012
Signature

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