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Personal

Full Name (First + Middle + Last)*

Address*

Street Address Address Line 2 City State ZIP Code

Phone #*

Email*

Are you authorized to work lawfully in the U.S?*

Single Source Systems participates in E-Verify. All newly hired employees are required to complete the employment eligibility verification form (Form I-9) as part of the hiring process. This information will be submitted to E-Verify to confirm their eligibility to work in the U.S.

Yes

Are you at least 18 years or older? (If no, you may be required to provide authorization to work and/or may not be eligible for certain hazardous occupations pursuant to federal and state laws)*

Yes

Employment Desired

Which Position(s) are you applying for?*

Click on a position title to view the job description.

# of years of experience*

In the field of:*

Hourly Rate/Salary Desired*

Date You Can Start*

Do you have a valid Driver’s License?*

Yes

Do you have a Real ID (with a gold star in the top right corner)?*

Yes

Do you have your own transportation?*

Yes

Are you afraid of heights? (average 25-30’)*

Yes

Are you bilingual?*

Yes

What is your primary and secondary languages?*

Referral Source

How did you hear about us?

Walk In

Referral

Other

Who referred you?*

Do you have any relatives or friends who work for our company?*

Yes

Names of friends or relatives employed in this organization

Employment History

Have you ever been employed by this organization before?*

Yes

If yes, list job title, dates, and location of employment*

Are you currently employed?*

Yes

May we contact your most recent employer?*

Yes

If yes, why are you considering leaving?*

Have you ever been discharged or asked to resign from a job?*

Yes

If yes, please explain.*

Employment History Details

Please provide your last ten (10) years of employment history, including periods of unemployment and U.S. Military Service. Start with your most recent employer and work backwards in time.

Company Name (Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

From

Job Title

Supervisors Name & Title

Base Rate of Pay (Hour/Week/Month)

Start

End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes

Did you have another job before this one?*

Yes

Company Name (Second Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

From

Job Title

Supervisors Name & Title

Base Rate of Pay (Hour/Week/Month)

Start

End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes

Would you like to list another previous job?

Yes

Company Name (Third Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

From

Job Title

Supervisors Name & Title

Base Rate of Pay (Hour/Week/Month)

Start

End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes

Would you like to list a 4th job?

Yes

Company Name (Fourth Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

From

Job Title

Supervisors Name & Title

Base Rate of Pay (Hour/Week/Month)

Start

End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes

Education

List your education history starting with highschool

Name

Number of Years

Subjects Studied/Major

Graduate or Degree

List any business or job related academic honors, achievements, extracurricular activities, or memberships in business or job related organizations.

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for?

Computer Skills (please describe)

Professional License and Membership

Type of License(s) Held

Other Professional Memberships (You may omit any that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status, veteran status or any other protected status)

References

List 3-5 people we may contact who are qualified to evaluate your capabilities. Do not include relatives. (Click the + button to add a new row)*

Name

Phone

Company

Job Title

Type of Relationship

Emergency Contacts

List 1-5 people we may contact in case of an emergency*

Name

Phone

Company

Job Title

Type of Relationship

Resume Upload (optional)

If you have a resume you'd like to attach, please do so here. This is not required.

Accepted file types: doc, docx, pages, odt, rtf, tex, txt, wpd, wps, pdf, Max. file size: 50 MB.

Would you like to add a cover letter?

Yes

Cover Letter (optional)

Please upload your cover letter here. You may also copy and paste the contents of your cover letter in the space below.

Max. file size: 50 MB.

Acknowledgement

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my termination.

Digital Signature:*

Printing your First Name + Middle Initial + Last Name will act as your digital signature.

Date

TRAVEL AGREEMENT

Iunderstand that traveling out of town for work is a requirement at Single Source. The amount of travel out of town is determined by the work schedule. Out of town travel is any jobsite that it 100 miles or more away from Single Source Corporate Offices at 100 W 2nd St., Peculiar, MO 64078. When traveling out of town for work, each employee will receive a per diem of $25.00 for each day they are required to stay overnight, in addition to $0.29 per mile for travel to and from the job site. Single Source will provide motel accommodations, which may be shared with another crew member.

Digital Signature:*

Printing your First Name + Middle Initial + Last Name will act as your digital signature.

Date*

Concrete

Warehouse Installation Services

Personal

Employment Desired

Referral Source

Employment History

Employment History Details

Education

Professional License and Membership

References

Emergency Contacts

Acknowledgement

TRAVEL AGREEMENT

Single Source Systems

Mailing Address

Material Handling Installations

Concrete Services

Get in Touch

Concrete

Warehouse Installation Services

Personal

Employment Desired

Referral Source

Employment History

Employment History Details

Education

Professional License and Membership

References

Emergency Contacts

Acknowledgement

TRAVEL AGREEMENT

Single Source Systems

Mailing Address

Material Handling Installations

Concrete Services

Get in Touch

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