Colorado Asphalt Services, Inc., pavement, potholes roads, parking lots

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Welcome to the Colorado Asphalt Services, Inc. (CASI) Internet web site.

Employment Application:

Thank you for considering employment with Colorado Asphalt Services, Inc. (CASI). If you are interested in a postion with CASI listed on the previous page please fill out the online application below (you can print out a copy for your records after you click on the Submit button below). You can also fill out an application at our office (Go to our CONTACT US for address and map). For a blank Adobe .pdf version of our Employment Application, please click HERE.

Employment Application

APPLICANT INSTRUCTIONS

If you need help filling out this application form or for any phase of the employment process, please contact CASI and every effort
will be made to accommodate your needs in a reasonable amount of time.

1. Please read “APPLICANT NOTE” below.
2. Complete the entire form.
3. If more space is needed to complete any questions, use comments section at the bottom of the form.
4. Incomplete applications will not be processed. PLEASE TYPE “NOT APPLICABLE” IF YOUR ARE NOT ANSWERING A QUESTION.
5. Provide only requested information. Failure to do so may result in disqualification of your application.

Position Applied For:

Name:

Last

First

Social Security Number:

Phone:

Home:

Work:

Current Address:

City

State

Zip

If less than 2 years at the current address, please complete:

Prior Address:

City

State

Zip

Availability

Date you can start:

Preferred Category:

Full Time Part Time Temporary (choose only one)

Schedules Available*:

Week Days Week Ends Evenings Nights Overtime

Check all that apply

If other, please specify:

*Reasonable effort will be made to accommodate sincerely held moral and ethical beliefs (WI) religious beliefs and practices (All other States)

Job Related Skills

Yes No

Do you have a valid Drivers License?

Name on Drivers License:

DL #:

Type:

State of Issue:

Yes No

Have you had any moving violations within the last seven years?

Please Describe:

Please list any other skills, licenses or certificates that may be job related or that you feel would be of value to this job or company:

Yes No

Have you been given a job description or had the essential functions of the job explained to you?

Yes No

If "yes" to the above question, do you understand these essential functions?

Yes No

Can you perform the essential functions of this job with or without reasonable accommodation?

Security

List states and counties of residence for the past seven years (starting with the most current):

State

County

Yes No

Have you used any names or Social Security Numbers other than given above? If so, please list in comments below.

Yes No

Have you been convicted of a crime in the past seven years? If so, please describe in the boxes below:

NOTE: Applicant is not obligated to disclose any reference to a pre or post trial diversion program, any conviction which has been sealed, expunged or erased by the court, or, if in California, any marijuana related misdemeanor conviction entered more than two years prior to the date of this employment application. (Conviction will not necessarily be a bar to employment. In accordance with company policy and applicable state and federal laws, factors such as age at time of the offense, remoteness of the offense, time since last conviction, nature of the job sought and rehabilitation effort will be reviewed.)

Incident	City/State	Charge

Comments:

Previous Employers

PLEASE NOTE: Your application will not be considered unless every question in this section is answered. Since we will
make every effort to contact previous employers, the correct telephone numbers of past employers are critical. Consult a
phone book or call information if necessary. FOR EMPLOYERS OUTSIDE THE U.S., A CURRENT FAX NUMBER IS
MANDATORY.

Most Recent Employer

Phone:	FAX:

Company Name:

City	State

Dates Employed:

From:	To:

Job Title:

Supervisor:

Duties:

Salary:

Per Hour Week Bi-Weekly Month (check only one)

Reason for leaving:

Yes No

Are you currently working for this employer?

Yes No

If yes, may we contact them?

Second Most Recent Employer

Phone:	FAX:

Company Name:

City	State

Dates Employed:

From:	To:

Job Title:

Supervisor:

Duties:

Salary:

Per Hour Week Bi-Weekly Month (check only one)

Reason for leaving:

Third Most Recent Employer

Phone:	FAX:

Company Name:

City	State

Dates Employed:

From:	To:

Job Title:

Supervisor:

Duties:

Salary:

Per Hour Week Bi-Weekly Month (check only one)

Reason for leaving:

References

Include only individuals familiar with your work ability. Do not include relatives or names of supervisors listed above.

Name:	Address/Phone	Years Known/Relationship

Education

NOTE: Do not fill out any part of this section you believe to be non-job related.

Please indicate highest grade completed (check only one):

7th 8th 9th 10th 11th 12th
Some College College grad Post grad

If your school records are under a different name than listed on application, please enter that name:

	Name:	City/State:	Graduated:	Degree Type:
High School			Yes No
College			Yes No
Other			Yes No

Certification and Release

I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information. I release all former employers, persons, schools, companies and law enforcement authorities from any liability or any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited while employed by CASI, whether during business hours or not. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

Electronic Signature: Date:

APPLICANT NOTE
This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination based on sex, marital status, race, color, age, creed, national origin, sexual orientation, military reserve membership, ancestry, religion, height, weight, use of a guide or support animal because of blindness, deafness or physical handicap, or the presence of disabilities. A conviction will not necessarily bar an applicant from employment. Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment. After an offer of employment, and prior to reporting to work, you may be required to submit to a medical review. Depending on company policy and the needs of the job, you will be required to complete a medical history form and may be required to be examined by a medical professional designated by the company.

(Reseting clears entire form)

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