Applicant Information
First Name*
Middle Name*
Last Name*
Street Address*
Apartment/Unit #
City*
State*
Zip Code*
Phone Number*
Email Address*
Date Available*
Social Security No.*
Desired Wage*
Desired Position*
Please check all of the positions of interest.
- Laborer - Pipe
- Laborer - General
- Pipelayer
- Operator - Excavator
- Operator - Loader
- Operator - Crane
- Operator - Dump Truck
- Mechanic - Heavy Equipment
- Superintendent
- Project Manager
- Estimator
- Administrative Assistant
- Other - Please specify in remarks.
If "Other", please explain in remarks below:*
Do you have a valid Virginia's driver's License?*
- Yes
- No
Are you willing to provide a Virginia Motor Vehicle record at your expense?*
- Yes
- No
Have you ever worked for this company?*
- Yes
- No
During the last ten years, have you ever been convicted of a crime other than a minor traffic offense or an offense prohibited from being disclosed under Va. Code § 19.2-389.3?*
- Yes
- No
Please explain in remarks below:*
Have you ever been convicted of a crime that would require you to register in any U.S. state as a sex offender?*
- Yes
- No
Please explain in remarks below:*
Are you at least 18 years of age?*
- Yes
- No
Are you legally eligible for employment in the United States?*
- Yes
- No
Introduce yourself*
Write a few paragraphs telling us a little about yourself.

Reference 1
Full Name*
Company
(If Applicable)
Relationship*
Phone*
Address*

Reference 2
Full Name*
Company
(If Applicable)
Relationship*
Phone*
Address*

Reference 3
Full Name*
Company
(If Applicable)
Relationship*
Phone*
Address*

Employment History
Employer 1
Company*
Street Address*
City*
State*
Zip Code*
Phone*
Supervisor*
Job Title*
Wage*
Began Employment
Month*
Year*
Left Employment
Month*
Year*
Reason for Leaving*
I'd like to add a second employer.
- Yes
Employer 2
Company
Street Address
City
State
Zip Code
Phone
Supervisor
Job Title
Wage
Began Employment
Month
Year
Ended Employment
Month
Year
Reason for Leaving
I'd like to add a third employer.
- Yes
Employer 3
Company
Street Address
Phone
Supervisor
Job Title
Wage
Began Employment
Month
Year
Ended Employment
Month
Year
Reason for Leaving

Military Service
Please skip to the next page if this does not apply.
Branch
From (year):
To (year):
Rank at Discharge
Type of Discharge
If other than honorable, explain:

Disclaimer and Signature
PLEASE READ CAREFULLY: By submitting this application: I certify that all information contained within it is true, complete, and without misrepresentation 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. I authorize anyone possessing information regarding my previous employment, character, and/or driving and/or criminal record(s) to provide said information to F. L. Showalter, Inc.’s officers, employees, and agents acting on behalf of the organization upon request. I hereby release all of F. L. Showalter, Inc.’s shareholders, officers, employees, and agents from all liability in gathering and using said information. If employment is obtained under this application, I agree a) to conform to the policies and procedures of F. L. Showalter, Inc. during my tenure, including submission to random and reasonable suspicion substance abuse screenings when requested and b) that my employment will be “at will” (as defined by the Commonwealth of Virginia) meaning that F. L. Showalter, Inc. may end the employment relationship at any time, for any reason, or for no reason.
*
- I agree
Signature*
Please type your name.
Date Signed*
Applicants are responsible for the cos of pre-employment drug screening and will be reimbursed upon results proving negative for any illegal drug, or alcohol use, whether the applicant is hired or not. DOT $45.00 NON-DOT $35.00

New Employee Application

Step 1 of 8

Applicant Information

Education

Reference 1

Reference 2

Reference 3

Employment History

Military Service

Disclaimer and Signature