Application For Employment

Thank you for your interest in Terra Engineering & Construction Corporation (Terra.) Terra is an Equal Opportunity/Affirmative Action Employer and does not discriminate on the basis of race, religion, color, age, marital status, disability, sex, sexual orientation, gender identity, national origin, veteran status, arrest or conviction record or any other basis prohibited by state, federal or local law. This application will be considered active for a period of 30 days. After that time, if you wish to be considered for employment, you must reapply.

Name*

First Middle Last

Address*

Street Address City State Zip

Daytime Phone Number*

Evening Phone Number

Email*

I can provide proof of a legal right to work in the USA*

Yes
No

If under 18 years of age, I can furnish a work permit*

Yes
No

I was previously employed by Terra Engineering & Construction*

Yes
No

If yes, please indicate in what capacity, when and to whom you reported:*

For position(s) requiring valid driver's license: I have a driver's licence:

Yes
No

If yes, please indicate:*

State & Driver's Licence Number

I have been convicted of a crime other than a minor traffic violation:*

Yes
No

If yes, please give date(s), offense(s), and charge(s)*

A conviction will not automatically bar you from employment. Each conviction will be considered with respect to time, circumstances, and relationship to job applied for.

I am related to a current Terra Engineering & Construction employee*

Yes
No

If yes, please indicate below: Name(s), Relationship(s) & Department(s)*

Are you subject to any restrictions on your ability or availability to work the hours required, which may exceed 8 per day and 40 per week, or on certain days or occasions?

Yes
No

If yes, please explain.

It is the policy of Terra Engineering & Construction Corporation to provide reasonable accommodations to individuals whose inability to work certain hours or on certain days is due to the individual’s religious observances or for other reasons protected under applicable local, state or federal laws, unless to do so would cause a hardship.

Are you subject to any employment agreements or post-employment agreements with any other employers including but not limited to employment contracts, non-compete or non-solicitation of customer or employee agreements, intellectual property rights agreements and/or confidentiality agreements?

Yes
No

If yes, attach a complete and accurate copy of each agreement.

Max. file size: 128 MB.

EMPLOYMENT DESIRED

Type of Work Desired

Skilled Trades
Office/Clerical/Administrative
Management/Engineer
Yard

Position(s) applying for:*

I am interested in:

Full Time
Part Time

Date you are able to start:*

Salary Requirements:*

Rate of pay you expect per hour

EDUCATION

List your educational experience which you believe is relevant for the position you are applying for.

High School

or Elementary if you did not attend High School

Name and Location:*

Years Completed:*

Did You Graduate?*

Yes
No

Course of Study:*

Overall Grade Average:*

College

Name and Location:

Years Completed:

Did You Graduate?

Yes
No

Course of Study:

Overall Grade Average:

Other Education

Graduate work, trade school, other

Name and Location:

Years Completed:

Did You Graduate?

Yes
No

Course of Study:

List any additional achievements, activities, honors, organizations and offices held which you feel are pertinent to this application:

PREVIOUS EMPLOYMENT

Resume

Max. file size: 128 MB.

I am currently employed*

Yes
No

You may contact my present employer*

Yes
No

Employer 1

Company Name*

Name & Title of Immediate Supervisor:*

Company Address*

Street Address Address Line 2 City State ZIP Code

Starting Job Title:*

Ending Job Title:*

Job Duties:*

Dates of Employment*

MM/YYYY - MM/YYYY

Employment Status*

Full-Time
Part-Time

Starting Salary:*

Ending Salary:*

Reason for Leaving:*

Employer 2

Company Name

Name & Title of Immediate Supervisor:

Company Address

Street Address Address Line 2 City State ZIP Code

Starting Job Title:

Ending Job Title:

Job Duties:

Dates of Employment

MM/YYYY - MM/YYYY

Employment Status

Full-Time
Part-Time

Starting Salary:

Ending Salary:

Reason for Leaving:

Employer 3

Company Name

Name & Title of Immediate Supervisor:

Company Address

Street Address Address Line 2 City State ZIP Code

Starting Job Title:

Ending Job Title:

Job Duties:

Dates of Employment

MM/YYYY - MM/YYYY

Employment Status

Full-Time
Part-Time

Starting Salary:

Ending Salary:

Reason for Leaving:

References

List 3 people - preferably past supervisors. Do not include relatives.

Reference 1

Name*

First Last

Occupation*

Years Known*

Phone Number*

Email*

Reference 2

Name*

First Last

Occupation*

Years Known*

Phone Number*

Email*

Reference 3

Name*

First Last

Occupation*

Years Known*

Phone Number*

Email*

APPLICANT AUTHORIZATION

Please read thoroughly - then accept

I certify that the facts set forth in this application are true, correct and complete without misrepresentations or omissions of any kind whatsoever and I authorize an investigation of the statements I have made herein. I hereby release from any and all liability all representatives of Terra for their acts performed in connection with evaluating my application, background, credentials and qualifications. I hereby further authorize any party (including the companies, schools and organizations with which I have been connected) to release any information they may have about me to Terra including all of my personnel records, any information about my performance during my employment with them and transcripts from any schools I have attended. I also release all persons, companies, schools and organizations (and all persons connected with them) who provide such information to Terra from any and all liability for damage for providing this information. I understand that if any of the information in this application form is discovered to be incorrect, false or misleading or if there are any misrepresentations or omissions of any kind whatsoever, then Terra may deny me employment or terminate my employment, and I agree that Terra shall not be liable in any respect if it does so. I also understand that my employment with Terra is contingent upon the satisfactory completion of a background check which may include a medical examination, a drug screen and an investigation of my work record and references. I understand that if I am employed by Terra, any such employment is not binding on either party for any specific period of time. I further understand that no representative of Terra, other than an Officer, has any authority to enter into any agreement for employment for any specified period of time. Any such agreement must be in writing and signed by an Officer. I understand that any other written or oral statement to the contrary, even if made by a supervisor, manager or Officer of Terra is invalid and should not be relied upon by me. I understand that if employed I will be an employee-at-will and that either Terra or I may terminate that employment relationship at any time, for any reason, with or without notice. A photocopy of this authorization may be used by Terra Engineering & Construction Corporation and shall be as valid as the original.

Acceptance & Signature*

I agree to the above conditions and to Terra Engineering & Construction Privacy Policy

Name

First Middle Last