**The following page 1 questions will help us to qualify you for employment at Pedersen Excavating. You are not required to respond. Equipment Operated:

An Equal Opportunity Employer


Employment History

Start with your present or most recent employer and DO NOT SKIP any employment. Include military experience.

Please include: 1.) employer's name, 2.) the dates you were employed, 3.) employer's address & phone #, 4.) your title, 5.) supervisor, 6.) hourly rate (starting & ending), 7.) work performed, 8.) reason for leaving
Please include: 1.) employer's name, 2.) the dates you were employed, 3.) employer's address & phone #, 4.) your title, 5.) supervisor, 6.) hourly rate (starting & ending), 7.) work performed, 8.) reason for leaving
Please include: 1.) employer's name, 2.) the dates you were employed, 3.) employer's address & phone #, 4.) your title, 5.) supervisor, 6.) hourly rate (starting & ending), 7.) work performed, 8.) reason for leaving

References

Do not include family members or past supervisors

Please include: 1.) Name, 2.) Phone, 3.) Occupation, 4.) Best time to call
Please include: 1.) Name, 2.) Phone, 3.) Occupation, 4.) Best time to call
Please include: 1.) Name, 2.) Phone, 3.) Occupation, 4.) Best time to call

Education

Please include: 1.) School, 2.) Location, 3.) Number of years completed, 4.) Diploma/Degree
Please include: 1.) School, 2.) Location, 3.) Number of years completed, 4.) Diploma/Degree
Please include: 1.) School, 2.) Location, 3.) Number of years completed, 4.) Diploma/Degree

Miscellaneous

Applicant's Knowledge

I certify that the information provided in this application for employment is true, correct, and complete. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. If as a candidate for employment I provide false or misleading information, my application or offer of employment will be cancelled indefinitely. I authorize complete investigation of all information provided in this application for employment. I hereby release from liability Pedersen Excavating Inc. and its representatives in securing job-related information from the sources I have listed herein. I also release my sources listed to provide such job-related information as may be requested by Pedersen Excavating Inc. This application for employment will be considered current and active for a period of 45 days following the date of submission. If I am considered for a position at any time after today, I will be asked if anything on my application has changed, and if so, I will be required to update my application accordingly. I understand that neither this document nor any offer of employment from Pedersen Excavating Inc. constitutes an employment contract. Pedersen Excavating Inc. is an equal opportunity employer. Applicants are considered for all positions, and employees are treated during employment, without regard to race, color, religion, sex, national origin, disability, or any other prohibited basis of discrimination, as provided under applicable state and federal law. Acceptance of an offer of employment does not create a contractual obligation upon Pedersen Excavating Inc. to continue to employ me. Any employment relationship with this organization is of an "at will" nature which means I may resign at any time and Pedersen Excavating Inc. may terminate my employment any time, with or without cause, with or without notice. If I accept an offer of employment from Pedersen Excavating Inc., I understand that I will be provided a copy of the employee handbook, safety policy, drug-free workplace notice, and other general information as pertains to my employment with this company. I hereby agree to read such materials and abide by the guidelines set forth in each. If I accept an offer of employment from Pedersen Excavating Inc., I will be requested to provide my consent to: 1) a drug screen, 2) pre-employment physical and, 3) enforcement of the Pedersen Excavating Inc. drug and alcohol policy provisions. An offer of employment made by Pedersen Excavating Inc. as a result of this application is specifically conditioned upon a negative drug screen result and completing a pre-employment physical with establishment of the fact that a potential employee may perform essential functions of the job with or without reasonable accommodations. By checking this box you are acknowledging you have read, understand, and consent to the above conditions of employment.

Pedersen Excavating, Inc.

Address: 3206 Fairground Loop
Spearfish, SD 57783

Phone: 605.642.3658

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