EMPLOYMENT

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FIRST NAME

MIDDLE NAME

LAST NAME

PHONE NUMBER

ADDRESS

CITY

STATE

ZIP CODE

GENERAL INFORMATION

SSN

ARE YOU EMPLOYED NOW?

INCOME EXPECTED

ARE YOU WILLING AND ABLE TO TRAVEL IF YOUR JOB REQUIRES IT?

WHEN ARE YOU AVAILABLE TO WORK?

What are your current job duties or skills?

What position are you applying for at MILLER?

HOW WERE YOU REFERRED TO MILLER?

DO YOU HAVE CURRENT MSHA TRAINING?

Files

YOU MUST PROVIDE PROOF OF IDENTITY AND EMPLOYMENT ELIGIBILITY UPON HIRE.

Are you a U.S. citizen, lawful permanent resident or otherwise authorized to work in U.S. without restriction?

DO YOU HAVE A VALID DRIVER'S LICENSE?

DRIVERS LICENCE NUMBER

REFERENCES

Give a list of 3 persons not related to you, whom you have known at least 1 year.

1ST REFERENCE

NAME

PHONE NUMBER

PERIOD KNOWN

RELATIONSHIP

2ND REFERENCE

NAME

PHONE NUMBER

PERIOD KNOWN

RELATIONSHIP

3RD REFERENCE

NAME

PHONE NUMBER

PERIOD KNOWN

RELATIONSHIP

EMPLOYMENT

1st Employer

PREVIOUS EMPLOYER

CONTACT NAME

PHONE NUMBER

SALARY

2nd Employer

PREVIOUS EMPLOYER

CONTACT NAME

PHONE NUMBER

SALARY

3rd Employer

PREVIOUS EMPLOYER

CONTACT NAME

PHONE NUMBER

SALARY

ACKNOWLEDGEMENTS

Employment is contingent upon passing a pre-employment drug screening.

I authorize MILLER to verify my suitability for employment and the information provided in this application with any person or organization.

All qualified applicants will receive consideration for employment without regard to sex, race, color, sexual orientation, national origin or ancestry, age, or disability. MILLER is an equal opportunity employer.

I agree that, if hired, I will observe all policies and strict confidentiality all affairs of this company and its members.

I declare that I understand that this is an application for a position only and does not imply any promises of employment on behalf of MILLER and that this application may be kept on file for a period of 1 year for future employment references of this company.

I the undersigned applicant hereby declare that all of the information on this application employment form is accurate and true and I understand that any falsehood or omission on my part may be grounds for future dismissal from the position or withdrawal of an offer of employment.

UPLOAD RESUME

RESUME UPLOAD

Date

By checking this box I acknowledge all of the above form to be true and consent to these terms.

I agree -You must select this to proceed

EMPLOYMENT

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miller contracting

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