Employment - Fogarty Concrete Construction

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Welcome to the Fogarty Concrete Application for Employment

Applicant Information

Position Applied for:(Required)

Name(Required)

First Middle Last

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Birthdate(Required)

Month

Day

Year

Social Security No.(Required)

xxx – xx – xxxx

Driver's License Number(Required)

Do you have dependable transportation?(Required)

Yes

Professional Information

Trade(Required)

Union Local #

Area / Location #

Current on Dues?

Yes

If applying for a Driver Position, do you have a CDL?(Required)

Yes

Air Brake Endorsement?(Required)

Yes

Are you a citizen of the United States?(Required)

Yes

If no, are you authorized to work in the US?(Required)

Yes

Have you ever worked for this company?(Required)

Yes

If so, when?(Required)

mm / yyyy

Have you ever been convicted of a crime?(Required)

Yes

If yes, explain.(Required)

If you are hired by Fogarty Concrete, this will become your W-4 Form.

How would you like your taxes withheld?

STATE:(Required)

Married

Single

STATE: Number of Exemptions(Required)

Enter Number

FEDERAL:(Required)

Married

Single

FEDERAL: Number of Exemptions(Required)

Enter Number

Who should we contact in case of an emergency?(Required)

First Last

Phone(Required)

Relationship(Required)

A copy of your Union Card, Driver's License or ID, Social Security Card, and OSHA Certifications are required for employment.

For your convenience, you can upload the image files of these documents here.

Union Card

Accepted file types: jpg, Max. file size: 128 MB.

Driver's License or ID

Accepted file types: jpg, Max. file size: 128 MB.

Social Security Card

Accepted file types: jpg, Max. file size: 128 MB.

OSHA Certifications

Accepted file types: jpg, Max. file size: 128 MB.

Fogarty Concrete Employment Application, continued

Work Experience

Select all that apply.

Footings

Wood Forms

House Slabs

Pavement

Read Blueprints

Laser

Rotary Hammer

Walls

Aluminum Forms

Garage Slabs

Curbs

Layout

Concrete Saw

Generator

Vibrator

Basement Slabs

Walks

Troweling Machine

Run a Skidsteer

Compressor / Jackhammer

Concrete Buggy

Please provide any additional skills or experience that may be helpful.

References

Most Recent Company you have worked for:(Required)

Company Name

Foreman

First Last

Phone(Required)

Foundations

Flatwork

Would you like to include a second reference?(Required)

Yes

Next Recent Company you have worked for:

Company Name

Foreman

First Last

Phone

Foundations

Flatwork

Would you like to include a third reference?(Required)

Yes

Recent Company you have worked for:

Company Name

Foreman

First Last

Phone

Foundations

Flatwork

Would you like to include a fourth reference?(Required)

Yes

Recent Company you have worked for:

Company Name

Foreman

First Last

Phone

Foundations

Flatwork

Are you a Veteran?(Required)

Yes

Please Indicate Race (Required)

White

African American

Hispanic or Latino

Korean

Japanese

Native Hawaiian

column2

American Indian

Alaska Native

Chinese

Samoan

Chamorro

Other Asian

column3

Filipino

Asian Indian

Vietnamese

Other Pacific Islander

Other

No Comment

This information is strictly used for Certified Payroll and Union employment verification. Fogarty Concrete Construction, Inc does NOT discriminate or use race in evaluating job applications.

Disclaimer and Signature

Certification

Disclaimer and Signature(Required)

I certify that my answers are true and complete 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.

Electronic Signature

Date

MM slash DD slash YYYY