Application for Employment

Client Name: Terry Roberts Site Work, Inc.

Terry Roberts Site Work is a Drug-Free Employer

TO APPLICANT: We appreciate your interest in TERRY ROBERTS SITE WORK, INC and assure you that we are interested in your qualifications. A clear and full understanding of your background and work history will aid us in placing you in a position that best meets your qualifications.

Applicants will be considered without discrimination because of race, color, sex, age, religion, national origin, disability, veteran’s status, or any category protected by applicable law. Client/TERRY ROBERTS SITE WORK also provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act (ADA) and applicable state and local laws.

If a license is required for the position for which are applying (driver’s or other), please list the following:

Education School Name and Location Course of Study Graduate? # of years Degree/Diploma
High School

List below all present & past employment beginning with most recent.

I certify that all information on this application, my resume, and all supporting documents is correct, and I understand that any misrepresentation or omission of any information may result in disqualification from consideration of employment or, if employed, my termination.

I understand that this application is not a contract, offer, or promise of employment. If hired, I will be able to resign at any time for any reason. I further understand that a credit and background check may be made including, but not limited to, consumer credit history, driving record, employment, military, education and general public records which will provide information concerning my character, general reputation and mode of living. I hereby authorize my former employers, educational institutions and individuals named to furnish all information pertaining to my work and educational record. I release my formers employers, educational institutions, supervisors, co-workers and references from all liability on account of furnishing TERRY ROBERTS SITE WORK, the client to which I am assigned, and their agents. I further release TERRY ROBERTS SITE WORK, the client to which I am assigned, and their agents from any liability as the result of such contacts and in connection with obtaining any credit and background checks. Should a credit report be requested, I understand and agree that a separate authorization form will be utilized, as required by law.

If required by law, copy of this report will be provided to me. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. I understand and agree that, as a condition for employment, I may be required to sign a non-compete agreement and/or a conflict of interest statement.

I understand that TERRY ROBERTS SITE WORK or the client to which I am assigned may now have, or may establish, a drug-free workplace or a post-accident drug-testing program. If either has one now or implements one in the future, and I am offered a conditional offer of employment, I agree to work under the conditions requiring a drug-free workplace. I also understand and agree that I may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol and/or drugs as a condition of continued at-will employment, and following any work-related injury. I also agree to undergo random, fitness for duty, return to work, and reasonable suspicion of alcohol and drug testing. Refusal to take such tests when asked may result in termination.

I understand this company hires only U.S. citizens or individuals who are legally eligible to work in the United States.

This application is current for only sixty (60) days. At the conclusion of this time, of you have not heard from the Employer and still wish to be considered for employment, it will be necessary for you to complete a new application.