Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Are you 18 years of age or older? *

Yes

No

Are you able to provide proof of your identity and eligibility to work in the United States within 3 days of hire? *

Yes

No

Do you have a valid driver's license? *

Yes

No

Do you have a valid commercial driver's license? *

Yes

No

Construction work requires strenuous physical activity, such as: climbing several flights of stairs or ladders uninterrupted, working at heights, lifting at least 70 pounds, repetitive lifting, working 40 to 60 hours per week, and other activities. Are you able to perform these tasks with or without reasonable accommodation? *

Yes

No

Application Terms & Conditions *

I certify that the statements made on this Application and any accompanying resume are true and correct to the best of my knowledge. I understand that falsification, misrepresentation or omission of facts on this Application, or otherwise during the interview and hiring process, is cause for denial of employment or if employed, dismissal regardless of when the falsification, misrepresentation or omission is discovered. I authorize Leavesley Construction, LLC through its employees and/or agents to thoroughly investigate all statements contained in this Application, as well as my background, references, employment records, and other matters related to my suitability for employment. I further authorize Leavesley Construction, LLC to contact my present or past employer(s); educational institutions; federal, state, or municipal agencies; military services; and any other entities or individuals named or otherwise referred to by me in my Application and related documentation, or conversation conducted with authorized hiring personnel, in connection with my Application for employment with Leavesley Construction, LLC I fully indemnify, release, and hold harmless all such parties from any liability and responsibility that may arise in connection with obtaining or providing such information. This authorization is valid from the date I sign this Application and, if I am hired, for the duration of my employment at Leavesley Construction, LLC, I understand that any employment that might be offered to me by Leavesley Construction, LLC will be conditioned on a post-offer/pre-employment Fitness for Duty test which includes testing for illegal substances and alcohol. Such a test may be required. Failure or refusal to take the test will mean that I am disqualified for employment. If I take the Fitness for Duty test, but I fail to pass it, I will be ineligible for employment. If employed, I agree to abide by the policies and procedures of Leavesley Construction, LLC I understand that Leavesley Construction, LLC is an “employment-at-will” employer, and any employment with Leavesley Construction, LLC will be for no fixed period of time and may be terminated by me or the Company at any time, with or without any particular reason, notice or procedure. I further understand that no manager or supervisor or other representative of Leavesley Construction, LLC can make promises or agreements contrary to at-will employment without the written approval of the owner of Leavesley Construction, LLC, and that no offer of employment for a fixed period of time is valid unless in writing and signed by the owner of the company.

I agree to these terms and conditions.

Date *

MM

DD

YYYY