Interview


Left Coast Construction Inc. is an Equal Opportunity Employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, religion, national origin, disability/handicap or marital status. If you require reasonable accommodation in completing this form, please inform us.

First Name
Middle Name
Last Name
Street Address
Apt/Unit
City
State
Zip
Cell Phone
Other Phone
Type of Work Desired
Full Time
Part Time
Are you 18 years of age or Older?
If under 18, please state your age

(If you are under 18, employment is subject to verification that you are of legal minimum age and can furnish any required work permit.)

Are you on lay-off subject to recall elsewhere:
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Date available for employment
Minimum Salary Requirement $

Have you every been convicted of a crime, entered a plea of nolo contender (no contest) to a crime, pled guilty to a crime, had adjudication withheld or received a suspended sentence (regardless of the ultimate adjudication) for a crime?

If yes, give details concerning the type crime, the date of the conviction or plea, the penalty imposed, and any other circumstances you deem relevant to a full understanding of what occurred (attach additional sheets if necessary).

Have you been arrested and charged with any misdemeanor or felony not disclosed above for which you are out on bail or free on your own recognizance pending disposition or trial (again, do not include minor traffic infractions for which no court appearance necessary?)
If yes, give details concerning the nature of the claims and defenses raised by the parties, the outcome of the action (e.g., settlement, jury verdict or other disposition), and any other circumstances you deem relevant to a full understanding of what occurred.

Have you ever been sued for causing the death of, or injury to any person, or damage to any property (e.g., for assault, battery, defamation, etc.)?

If yes, give details concerning the nature of the claims and defenses raised by the parties, the outcome of the action (e.g., settlement, jury verdict, or other disposition), and any other circumstances you deem relevant to a full understanding of what occurred (attach additional sheets if necessary).

****Note: Answering "Yes to the three previous questions is not an automatic bar to employment. Factors such as age at the time of the offense, seriousness and nature of the violation, relatedness to the job saught, and evidence of rehabilitation will be taken into account. However, please be be grounds for advised that a misstatement or omission in answering these questions may disciplinary actions, including discharge. ***
Number of Days Absent from Work Last Year
Do you have Transportation to Work?
Do you have ALL Tools To Do The Job You Are Appling for?
Last Employer Name
Last Employer Contact
Last Employer Phone
Prior Employer
Prior Employer Contact
Prior Employer Phone
Prior Employer 2
Prior Employer Contact
Prior Employer Phone
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