Application For Employment

Horsfield Companies, Inc. is an Equal Opportunity and Affirmative Action Employer. Women and minorities are encouraged to apply.

NOTICE TO THE APPLICANT: This application is used to evaluate your qualifications for employment.
Please answer ALL questions completely. This application is not an employment contract.

 

Please complete the form below
or click here to download and mail in application

Mail application to: 505 East Main Street, Epworth, IA 52046

Ex: Concrete Laborer, Pipe Laborer, Truck Driver, etc.
Date *
Date
Personal Information
Name *
Name
Address *
Address
Phone Number *
Phone Number
Date of Birth *
Date of Birth
Check any of the following that are applicable
Are you fluent in any languages other than English? *
Are you eligible for employment in the United States? *
Experience
What date can you start? *
What date can you start?
Are you available to work *
Have you worked for this company before? *
Can you travel if a job requires it? *
Are you currently on lay off and subject to recall at another company? *
Do you have a valid driver's license? *
Expiration Date
Expiration Date
Previous Employment
List your three most recent positions held, starting with the most recent first.
Address
Address
Supervisor
Supervisor
Phone Number
Phone Number
May we contact?
Address
Address
Supervisor
Supervisor
Phone Number
Phone Number
May we contact?
Address
Address
Supervisor
Supervisor
Phone Number
Phone Number
May we contact?
References
Reference 1
Reference 1
Phone Number
Phone Number
Reference 2
Reference 2
Phone Number
Phone Number
Reference 3
Reference 3
Phone Number
Phone Number
Special Skills and Qualifications
Have you attended *
VOLUNTARY SURVEY
Horsfield Companies Inc. is required by state and federal laws to furnish statistical data and to maintain records of certain population characteristics of those applying for jobs with us. The information you supply will be used for statistical purposes only. If you are offered employment with Horsfield Companies, Inc., it will not be used as employment criteria. Horsfield Companies Inc. is an equal employment opportunity employer supporting diversity in the workplace. Thank you for your cooperation in completing this form.
CERTIFICATION & RELEASE
I certify that the information contained herein is true, complete and accurate. I understand that false statements or omission on this application my result in rejection of my application, or if employed, discharge at any time during my employment. I authorize investigation of all information herein. I further authorize all individuals, companies, schools, corporations, courts, and law enforcement agencies to give you any and all information concerning me that they may have. I release all parties from all liability for any damage that may result from divulging or using this information. I understand and agree that, if hired, my employment is for definite periods of time and either I or the company may terminate the employment relationship at any time, with or without cause, and with or without notice. The employment relationship exists regardless of any other statements of policies to the contrary. I realize that under certain provisions of the law, I may be required to submit to a post offer pre­employment physical and/or drug and alcohol tests as a condition of my employment. I hereby agree to submit to this examination and/or test and permit disclosure of the results to the company.
Date *
Date