Join our Team of Employees at Blue Ribbon Concrete, Inc.

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Date You Can Start*

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Have you ever worked for this company?*

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When?*

Have you ever been convicted of a felony?*

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Please Explain*

Do you have a valid Driver's License?*

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Drivers License Number*

Drivers License Type*

Drivers License State*

Have you had your Driver's License suspended or revoked in the last three years?*

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Please explain why your license was suspended/revoked*

Do you have adequate transportation to get to work on time each day?*

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List any skills that would be of value to this job or company

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Past Employment

Previous Employer #1

Company Name

Job Title

How Long You Worked There

Previous Employer #2

Company Name

Job Title

How Long You Worked There

Are You Able To Do The Following?

Answer Yes or No

Standing*

1-10+ Hours per Day

Yes
No

Walking*

1-10+ Hours per Day

Yes
No

Bending/Stooping*

1-10+ Hours per Day

Yes
No

Kneeling*

1-10+ Hours per Day

Yes
No

Squatting*

1-10+ Hours per Day

Yes
No

Twisting*

1-10+ Hours per Day

Yes
No

Crawling*

1-10+ Hours per Day

Yes
No

Reach Above Shoulders*

1-10+ Hours per Day

Yes
No

Reach Waist-Shoulder*

1-10+ Hours per Day

Yes
No

Reach Knee-Waist*

1-10+ Hours per Day

Yes
No

Reach Floor-Knee*

1-10+ Hours per Day

Yes
No

lift/carry 51-100#*

Yes
No

Climb Stairs*

Yes
No

Climb Ladders/Scaffolding*

Yes
No

Work at Heights*

Yes
No

Repetitive Movements*

Yes
No

How Would You Rate Your...

Vision (to ensure safety of others)*

Good
Fair
Poor or None

Hearing (to ensure safety of others)*

Good
Fair
Poor or None

Tolerance of Heat*

Good
Fair
Poor or None

Tolerance of Cold*

Good
Fair
Poor or None

Verbal Communication in English*

Good
Fair
Poor or None

Written Communication in English*

Good
Fair
Poor or None

Verbal Communication in Spanish*

Good
Fair
Poor or None

Written Communication in Spanish*

Good
Fair
Poor or None

Disclaimer

By checking this box, I certify that my answers are true and correct.*

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

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Today's Date*

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Job Related Skills

Past Employment

Previous Employer #1

Previous Employer #2

Are You Able To Do The Following?

Answer Yes or No

How Would You Rate Your...

Disclaimer