Apply Now – The Pick and Shovel

Personal Information

Name*

First Last

Address*

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

Phone Number*

Mobile Number*

Email Address*

Are you a U.S. Citizen?*

Yes
No

Have You Ever Been Convicted of a Felony?*

Yes
No

If Selected for Employment are you Willing to Submit To a Pre-Employment Drug Screening Test?*

Yes
No

Position

Position You Are Applying For*

Desired Department*

Available Start Date*

Desired Pay*

Employment Desired*

Full Time
Part Time
Seasonal / Temporary

Shift Availability

Shift Availability*

Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday

Education

Schools Attended*

School Name	Location	Years Attended	Degree Received	Major

References

References*

Name	Title	Company	Phone

Employment History

Employer

Employer Name

Job Title

Dates Employed

Work Phone

Starting Pay Rate

Ending Pay Rate

Address

City

State

Zip

Upload Resume

Upload Cover Letter

Upload Photo

Signature

Signature Disclaimer*

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 release.

Name*

Date*

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