Employment Application | Hodgman Drainage

16536 Co Hwy 34
Dodge Center, MN 55927
507-528-2225
Fax 507-528-2210
www.hodgmandrainage.com

Personal Information

Full Name: ______________________________________________ Street Address: ___________________________________________ City: ___________________________ State: _______ Zip: _______ Home Phone: _________________

Business Phone: _______________
Have you ever applied for employment with us? o Yes o No If yes, when?:_____________

Position Desired
Title: ______________________________ Desired Salary: $_______
Type of employment: o Full-time o Part-time o Seasonal

Date Available:________________

*Much of our work is performed on weekends, holidays, or extended hours. Work schedules may be subject to change on a weekly basis.
Are you willing to travel? o Yes o No

*Employees in certain positions may be required to travel on an occasional basis. When required to travel, employees will be away from home one or more nights at a time. If offered a position that requires traveling, are you able to travel with reasonable notice? o Yes o No

Work Eligibility

Are you eligible to work in the United States? o Yes o No
Are you 17 or older? o Yes o No
Have you been convicted of or pleaded no contest to a felony within the last five years? o Yes o No

If yes, please explain: ______________________________________________________________

Have you been convicted of, pleaded guilty to, or pleaded no contest to, an act of dishonesty, or breach of trust or moral turpitude, such as misdemeanor petty theft, burglary, fraud, writing bad checks, and other related crimes within the last five (5) years? * o Yes o No

If yes, please explain: ________________________________________________________________

*Conviction of a crime, or pleading guilty to a criminal charge, will not necessarily disqualify you from the job for which you are applying. Each conviction or plea will be considered with respect to time, job relatedness, and other relevant factors.

Do you have other special training or skills (Licenses, computer software knowledge, machine operation experience, etc.)? ____________________________________________________________________________________

How did you hear of our organization?____________________________________________

Education

High School: __________________________________ City:______________ State: _______ # of Years Completed:______________ Did You Graduate? o Yes o No
College/Trade School: ______________________________City:______________ State: _____ Course of Study: ___________________________________ # of Years Completed:_______ Did You Graduate? o Yes o No
Degree: _______________ Certificate:________________

Employment History

Please give accurate and complete full-time employment record. Start with present or most recent employer. Include military experience if applicable. Please Complete all 3 Positions.

Position #1

Company Name: _________________________ City:_____________________ State: _______
Company Phone Number: ________________________
Job Title: ________________________ Name of Supervisor: ___________________________

Employed (Month and Year) From: _______ To: _______ Weekly Pay:_______
Describe your work: __________________________________________
May we contact this employer? Yes: _______ No: _______
If not, why not? _______________________________________________

Reason for leaving: ____________________________________________

Position #2

Describe your work: __________________________________________
May we contact this employer? Yes: _______ No: _______
If not, why not? _______________________________________________
Reason for leaving: ____________________________________________

Position #3

Company Name: _________________________ City:_____________________ State: _______

Company Phone Number: ________________________ Job Title: ________________________
Name of Supervisor: ___________________________
Employed (Month and Year) From: _______ To: _______ Weekly Pay:_______

Conditions of Employment

Hodgman Drainage Co. Inc. sets high standards for its employees, and compliance with these standards is a condition of employment. If you are offered a position with Hodgman Drainage Co. Inc., you need to carefully consider what we would require of you before you accept.
Following our standards of professionalism

Arriving on time
Maintaining a positive, enthusiastic attitude
Treating coworkers with respect
Being honest and dedicated in your work
Completing necessary training requirements
Following company policies and procedures
Following directions
Meeting standards of work quality and quantity
Accepting a work scheduleAre you willing and able to comply with all the requirements listed? o Yes o NoIf your answer is no, or if you have concerns about being able to comply with any of these requirements, please explain: _________________________________________________________ _________________________________________________________Agreement of the Transfer of InformationI declare the information provided by me in this application is true, correct, and complete to the best of my knowledge. I understand that if employed, any falsification, misstatement, or omission of fact in connection with my application, whether on this document or not, may result in immediate termination of employment. I authorize you to verify any and all information provided above.
I acknowledge that employment may be conditional upon successful completion of a substance abuse screening test as part of the Company’s pre- employment policy.

I acknowledge that if I become employed, I will be free to terminate my employment at any time for any reason, and that Hodgman Drainage Co. Inc. retains the same rights.

Signature: ________________________________________Date:__________

Printed Name: _________________________________________