Rolling Plains Construction — Job Application

1

Basic Applicant Information

Full Name *

Phone Number *

Email Address *

Street Address *

City *

State *

ZIP *

Position Applying For

Date Available to Start *

Desired Wage Range

Employment Type Interest *

Full-Time Part-Time Contract

2

Legal Employment Requirements

Are you at least 18 years old? *

Yes No

Are you legally authorized to work in the United States? *

Yes No

Can you provide documentation verifying your identity and work authorization if hired? *

Yes No

3

Position-Specific Pre-Screen

Where are you looking to work? *

Apache Junction, AZ Yard Arizona Statewide Out-of-State Travel

Willing to work overtime and weekends when required? *

Yes No

Able to stand, walk, lift, bend, and perform physical labor for a full shift? *

Yes No

Can you regularly lift 60 lbs. without assistance? *

Yes No

Do you have reliable transportation to and from work? *

Yes No

Have you ever worked in a manufacturing, fabrication, coating, or construction environment? *

Yes No

4

Safety Screening

Have you completed OSHA training?

Yes No

Have you worked under a formal safety program?

Yes No

Have you ever been required to wear — Check all that apply

Respirator Fall Protection Hearing Protection Protective Coatings PPE

5

Certifications & Qualifications

Current certifications — Check all that apply

OSHA 10 OSHA 30 AMPP Certification Forklift Certification CDL License First Aid/CPR

6

Employment History

List your last 3 employers.

Employer 1

Company Name

Job Title

Start Date

End Date

Employer 2

Company Name

Job Title

Start Date

End Date

Employer 3

Company Name

Job Title

Start Date

End Date

Have you ever been employed by Rolling Plains Construction? *

Yes No

8

Referrals

Names of anyone you know who currently works at Rolling Plains Construction

9

Resume Upload (Optional)

📄

Click to upload or drag and drop

PDF, DOC, DOCX up to 10 MB

10

Applicant Certification

I certify that all information provided in this application is true and complete to the best of my knowledge. I understand that false information may result in disqualification or termination. I acknowledge that employment with Rolling Plains Construction is at-will and may be terminated at any time by either party.

Electronic Signature (Full Name) *

Date *