Personal Data:
Are you at least 18 years of age?	Yes No
Full Name: (First, Middle, Last)
Street Address:
City:
State:
Zip Code:
County:
Telephone No:
Alternate No:
Email Address:
Do you have a current driver's license?	Yes No
Do you have personal transportation to the job site?	Yes No
If an offer is made, will you be able to show proof of eligibility to work under the citizenship and immigration laws?	Yes No
If you have been referred by a Lyons & Hohl employee, provide name of the referring employee.
Position(s) applied for:
Laborer   Equipment Operator   Equipment Repair & Maint.   Driver
Other, please identify: (If driver or equipment repair applicant, please complete the driver supplement to this application).
List any relatives employed by Lyons & Hohl:
Have you previously filed an application with Lyons & Hohl? Yes No
If yes, when and what position?
If an offer is made, when can you start?
Expected Salary (per hour)
Are you able to work:
Regular   Temp   Full Time   Part Time   Saturdays
Number of Hours Wanted
Have you ever been convicted or placed on probation for a felony? Yes No
If you answered "Yes," please give details:
A conviction will not necessarily disqualify you from the job for which you have applied.
Education: (List all schools as follows)
High School Name and Address:
Years Completed   Did you graduate? Yes No   GED? Yes No
College Name and Address:
Years Completed   Did you graduate? Yes No   Degree
Other:
Years Completed   Did you graduate? Yes No   Degree
List any experience or skills that you feel qualify you for the positions (s) that you are seeking:
Employment History:
If presently employed, why are you seeking other employment?
Provide the following information on your current and past employers for the last 5 years. Explain any gaps in employment in the comment section below.
(1) Name and Address of Employer:
From Month/Year   To Month/Year
Ending Salary   #of Hrs./Week
Title:
Describe Key Job Responsibilities
Reason For Leaving
Supervisor’s Name & Telephone
(2) Name and Address of Employer:
From Month/Year   To Month/Year
Ending Salary   #of Hrs./Week
Title:
Describe Key Job Responsibilities
Reason For Leaving
Supervisor’s Name & Telephone
(3) Name and Address of Employer:
From Month/Year   To Month/Year
Ending Salary   #of Hrs./Week
Title:
Describe Key Job Responsibilities
Reason For Leaving
Supervisor’s Name & Telephone
(4) Name and Address of Employer:
From Month/Year   To Month/Year
Ending Salary   #of Hrs./Week
Title:
Describe Key Job Responsibilities
Reason For Leaving
Supervisor’s Name & Telephone
Please explain gaps in employment:
References: Please provide three work references that are not relatives. If no work references are available, list three school or personal references that are not relatives.
Name Occupation/Title Telephone Years Known
Field and equipment positions at Lyons & Hohl have physical requirements as follows. are applying for one of these positions, please answer the following questions.
Are you able to lift 90 pounds up to 10 times per day, with or without accommodation? Yes No
Can you bend, stretch, reach, climb and stand throughout an 8-10 hour period, with or without accommodation? Yes No
If driving or operating equipment, can you sit for extended periods of time and climb in and out of a cab, with or without accommodation? Yes No
Can you work outside in variable as well as extreme hot and/or cold working conditions, with or without accommodation? Yes No
Applicant Statement (Please Read Carefully Before Submitting Form) I understand that if I am offered employment with Lyons & Hohl a drug screen for illegal / controlled substances will be required and any offer of employment Lyons & Hohl makes to me is contingent upon a negative result. I further understand that Lyons & Hohl has created a work environment that is free of drugs and alcohol, and, in its discretion, may require me to undergo testing for use of illegal / controlled substances and/or alcohol at any time during the course of my employment with it. I further authorize schools, references, former employers, and physicians or other medical practitioners to provide my record, reason for leaving employment, and all other job-related information they may have concerning me to the Company, and I release and hold harmless all parties providing job-related information from any and all liability or claims for damages that may result from this job-related information’s release, disclosure and use. I understand that unfavorable information Lyons & Hohl discovers as a result of this investigation may prevent my being hired, or if hired, may subject me to immediate dismissal. I certify that the information contained in this application is correct to the best of my knowledge and understanding. I agree to conform to the Company's rules and regulations, and as an at-will employee my employment and compensation can be terminated at any time with or without notice by either the Company or me.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement. Yes No