CAREERS

We are an Equal Opportunity Employer and fully subscribe to the principles of Equal Employment Opportunity. Applicants and/or employees are considered for hire, promotion and job status, without regard to race, color, religion, creed, sex, marital status, national origin, age, physical or mental disability.

Contact Information
Name*
First Middle Last
Other Name(s) Used
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Mobile Phone Number*
Home Phone Number

Personal Information
Date of Birth*
MM slash DD slash YYYY
Social Security Number*
Drivers License Number*
Drivers License State of Issuance*
Drivers License Issuance Date*
MM slash DD slash YYYY
Drivers License Expiration Date*
MM slash DD slash YYYY
Have you ever been convicted of any felonies other than minor traffic violations during the past seven (7) years?*
- Yes
- No
Note: A criminal record or a conviction will not automatically bar employment, but will be considered only as it reasonably relates to your fitness to perform in the position for which you are applying.
Please explain the nature of your felony.*
Are you able to perform the essential job functions of the position for which you are applying with or without reasonable accommodation?*
- Yes
- No

Education and Training
What is the highest level of education you completed?*
What is the highest grade level you completed in school?*
High School Name*
High School Address*
City State
High School Graduation*
MM slash DD slash YYYY
High School GPA
Technical/Vocational School Name*
Technical/Vocational School Address*
City State
Technical/Vocational School GPA*
College Name*
College/University Address*
City State
College GPA*
Please list any scholarships, academic honors, awards or special achievements you have earned.

Job Skills
Please list any skills you have that are appropriate for the position for which you are applying.*
If required, will you work overtime?*
- Yes
- No
If required, will you work Saturdays?*
- Yes
- No
If required, will you work Sundays?*
- Yes
- No
If required, will you work rotating shifts?*
- Yes
- No
What position (or positions) are you applying for? Be specific.*
What is your minimum salary requirement per hour?*
What date can you begin work?*
MM slash DD slash YYYY
Why do you feel you are qualified for this position?*
Interests and Accomplishments
You may wish to list any significant experience, interests, hobbies and accomplishments gained while working as a volunteer or hobbyist that may be useful in the position(s) you are seeking. Names or organizations designating religion, race, etc. need not be mentioned.

Employment History: Current/Most Recent Employer
Starting with your PRESENT or MOST RECENT EMPLOYER, list in consecutive order ALL employment for at least the past FOUR employers.
Are you currently employed?
- Yes
- No
If currently employed, may we contact your current employer?*
- Yes
- No
Most Recent Employer Company Name*
Employer Address
Street Address Address Line 2 City State ZIP Code
Employer Phone
Supervisor Name and Title
First Last Title
Your Position Title
List your jobs held, duties performed, skills used and any promotions while employed at this company.*
Starting salary per year*
Current/Ending salary per year*
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY

Employment History: Employer #2
Can you add another employer? (#2)*
- Yes
- No
Employer #2: Company Name*
Employer #2: Address
Street Address Address Line 2 City State ZIP Code
Employer #2: Phone
Employer #2: Supervisor Name and Title
First Last Title
Employer #2: Your Position Title
Employer #2: List your jobs held, duties performed, skills used and any promotions while employed at this company.*
Employer #2: Starting salary per year*
Employer #2: Ending salary per year*
Employer #2: Start Date*
MM slash DD slash YYYY
Employer #2: End Date*
MM slash DD slash YYYY

Employment History: Employer #3
Can you add another employer? (#3)*
- Yes
- No
Employer #3: Company Name*
Employer #3: Address
Street Address Address Line 2 City State ZIP Code
Employer #3: Phone
Employer #3: Supervisor Name and Title
First Last Title
Employer #3: Your Position Title
Employer #3: List your jobs held, duties performed, skills used and any promotions while employed at this company.*
Employer #3: Starting salary per year*
Employer #3: Ending salary per year*
Employer #3: Start Date*
MM slash DD slash YYYY
Employer #3: End Date*
MM slash DD slash YYYY

Employment History: Employer #4
Can you add another employer? (#4)*
- Yes
- No
Employer #4: Company Name*
Employer #4: Address
Street Address Address Line 2 City State ZIP Code
Employer #4: Phone
Employer #4: Supervisor Name and Title
First Last Title
Employer #4: Your Position Title
Employer #4: List your jobs held, duties performed, skills used and any promotions while employed at this company.*
Employer #4: Starting salary per year*
Employer #4: ending salary per year*
Employer #4: Start Date*
MM slash DD slash YYYY
Employer #4: End Date*
MM slash DD slash YYYY

Certification of Information Provided*
I certify that the information contained in this application is correct to the best of my knowledge and understand that any misstatement or omission of information may result in denial of employment or discharge. I authorize the references listed to give Kelly Road Builders Inc. any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to Kelly Road Builders, Inc.
I agree and consent
Consent for Background Check*
I hereby authorize Kelly Road Builders, Inc. to contact any and all corporations, former employers, educational institutions, law enforcement agencies, city, state, county, and federal courts, military services to release information about my background including, but not limited to, information about employment, education, driving record, criminal record and general public records history to Kelly Road Builders, Inc.

I release from liability all persons, companies, schools supplying such information. I indemnify Kelly Road Builders, Inc. against any liability, which may result from making such requests. This release shall remain in effect for the length of my employment. I understand and I may have a right to request additional disclosures regarding the nature and scope of the investigation.

I believe to the best of my knowledge that all information I have provided is accurate, true and correct and that I fully understand the terms of this release.
I agree and consent
Consent for Drug Screening*
I hereby agree to submit to testing to be performed by Employment Screening Services for detection of drugs and alcohol. I give permission for test results to be released to Kelly Road Builders, Inc.

I understand that positive test results, refusal to be tested, or any attempt to affect the test results or test sample will result in withdrawal of my application for employment, withdrawal of any provisional employment offer I have received from Kelly Road Builders, Inc. or termination of employment depending on when results are received.
I agree and consent
Motor Vehicle Report Request*
I hereby authorize Kelly Road Builders, Inc. to obtain my Motor Vehicle Report. I understand that Kelly Road Builders, Inc.'s insurance agency uses the Motor Vehicle Report to determine whether or not a driver is suitable to operate a company-insured vehicle. By agreeing, I hereby authorize Kelly Road Builders, Inc. to obtain this Motor Vehicle Report and share the information with its insurance agency.
I agree and consent
Signature*
Date of Application and Date Signed*
MM slash DD slash YYYY

Step 1 of 10

Contact Information

Personal Information

Education and Training

Job Skills

Employment History: Current/Most Recent Employer

Employment History: Employer #2

Employment History: Employer #3

Employment History: Employer #4