Application

First Name Middle Initial Last Name

Street Address

Apartment/Unit #

City State

ZIP Code

Phone

Email Address

Date of Birth

Social Security Number

Position Applying For

Desired Salary

Are you a citizen of the United States?

Yes No

If no, are you authorized to work in the U.S.?

Yes No

Do you currently have a valid Commercial Driver's License?

Yes No

Driver's License Number

State of Driver's License

Driver's License Class

Have you been convicted of a crime or any moving violations in the last five (5) years?

Yes No

If yes, explain

High School

Address

Attended From

to

Did you graduate?

Yes No

Degree

College

Address

Attended From

to

Did you graduate?

Yes No

Degree

Other

Address

Attended From

to

Did you graduate?

Yes No

Degree

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Company

Address

Phone

Job Title

Job Responsibilities

Supervisor's Name

Employed from

to

Starting Salary

Ending Salary

Reason for leaving

May we contact your previous supervisor for a reference?

Yes No

Company

Address

Phone

Job Title

Job Responsibilities

Supervisor's Name

Employed from

to

Starting Salary

Ending Salary

Reason for leaving

May we contact your previous supervisor for a reference?

Yes No

Company

Address

Phone

Job Title

Job Responsibilities

Supervisor's Name

Employed from

to

Starting Salary

Ending Salary

Reason for leaving

May we contact your previous supervisor for a reference?

Yes No

Branch

Service from

to

Rank at discharge

Type of discharge

If other than honorable, explain

Model

Type & Amount of Experience

Model

Type & Amount of Experience

Model

Type & Amount of Experience

Model

Type & Amount of Experience

Model

Type & Amount of Experience

Model

Type & Amount of Experience

Model

Type & Amount of Experience

Model

Type & Amount of Experience

Model

Type & Amount of Experience

Model

Type & Amount of Experience

Model

Type & Amount of Experience

Model

Type & Amount of Experience

I certify that my answers are true and complete to the best of my knowledge. I understand that if any of the information provided is not true, if there is any willful omission of facts or misrepresentation by me, such actions may be cause for my termination if I am employed. I authorize Paragon Paving, Inc., or any other vendors selected by Paragon Paving, Inc., to investigate and verify the above statements. If I am employed, I understand that my employment with Paragon Paving, Inc., will be on an at-will basis, unless otherwise agreed upon in writing by Paragon Paving, Inc., I also understand that if I am hired for employment, I will be able to provide Paragon Paving, Inc., proof of identity and legal work authorization documentation.

Signature

Clear

Today's Date

APPLICANT INFORMATION

NAME

ADDRESS

CONTACT & MISC

EMPLOYMENT DETAILS

CITIZENSHIP

DRIVER'S LICENSE

CRIMINAL BACKGROUND

EDUCATION

SECONDARY EDUCATION

POST-SECONDARY EDUCATION

OTHER EDUCATION

PROFESSIONAL REFERENCES

FIRST REFERENCE

SECOND REFERENCE

THIRD REFERENCE

PREVIOUS EMPLOYMENT

MOST RECENT EMPLOYER

SECOND MOST RECENT EMPLOYER

THIRD MOST RECENT EMPLOYER

MILITARY SERVICE

ANY EQUIPMENT EXPERIENCE

SKID LOADER

FRONT END LOADER

ASPHALT PAVERS/ROLLERS

DOZERS

CONCRETE EQUIPMENT

SNOW PLOWING

DUMP TRUCKS

TRACTOR/TRAILER

LOWBOY/SEMI

SWEEPERS

OTHER

LANDSCAPE EQUIPMENT

READ CAREFULLY AND ACKNOWLEDGE BY TYPING YOUR SIGNATURE AND TODAY'S DATE