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Employment Application Form
  1. Sierra Asphalt Inc. (the "Company") is an equal opportunity/affirmative action employer. All qualified applicants will be considered without regard to age,race, color, sex, religion, nation origin, marital status, ancestry, citizenship, veteran status, sexual orientation or preference, or physical or mental disability.

    Personal Contact Information:


  2. First Name(*)
    Please type your first name.
  3. Last Name(*)
    Please type your last name.
  4. Street Address(*)
    Please type your street address.
  5. City(*)
    Please type your city.
  6. State(*)
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  7. Zip Code(*)
    Use only numbers for example: 95610
  8. Home Phone
    Include area code for example: 916-555-4422
  9. Cell Phone
    Include area code for example: 916-555-4422
  10. E-mail(*)
    Type a valid email address.
  11.  
  1. Sierra Asphalt Inc. (the "Company") is an equal opportunity/affirmative action employer. All qualified applicants will be considered without regard to age,race, color, sex, religion, nation origin, marital status, ancestry, citizenship, veteran status, sexual orientation or preference, or physical or mental disability.

    Personal Details


  2. Highest Level of Education:(*)
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  3. Do you have two or more years of experience working as one of the following: (check all that apply)








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  4. Please list any special training, skills, military experience or certificates:
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  5. Do you consider yourself highly skilled operating any of the folllowing types of equipment: (check all that apply)








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  6. Position Applying For:
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  7. Hourly Wage Desired:
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  8. Date you can Start:
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  9. Have you applied with us before?
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  10. Do you have a valid driver's license?(*)
    Your answer is required.
  11. Are you at least 18 years old?(*)
    Your answer is required.
  12. Are you legally authorized to work in the U.S.A.?(*)
    Your answer is required.
  13.  
  1. Sierra Asphalt Inc. (the "Company") is an equal opportunity/affirmative action employer. All qualified applicants will be considered without regard to age,race, color, sex, religion, nation origin, marital status, ancestry, citizenship, veteran status, sexual orientation or preference, or physical or mental disability.

    Employment History - Employer #1


  2. Company Name:(*)
    Required Input
  3. Company City(*)
    Required Input
  4. Job Title:(*)
    Required Input
  5. Job Duties:(*)
    Required Input
  6. Start Date:(*)
    Required Input
  7. End Date:(*)
    Required Input
  8. Reason for leaving:(*)
    Required Input
  9. Ending Hourly Wage:
    Invalid Input
  10. May we contact this employer?(*)
    Required Input
  11. Supervisor Name:(*)
    Required Input
  12. Supervisor Phone:(*)
    Include area code for example: 916-555-4422
  13.  
  1. Sierra Asphalt Inc. (the "Company") is an equal opportunity/affirmative action employer. All qualified applicants will be considered without regard to age,race, color, sex, religion, nation origin, marital status, ancestry, citizenship, veteran status, sexual orientation or preference, or physical or mental disability.

    Employment History - Employer #2


  2. Company Name:(*)
    Required Input
  3. Company City(*)
    Required Input
  4. Job Title:(*)
    Required Input
  5. Job Duties:(*)
    Required Input
  6. Start Date:(*)
    Required Input
  7. End Date:(*)
    Required Input
  8. Reason for leaving:(*)
    Required Input
  9. Ending Hourly Wage:
    Invalid Input
  10. May we contact this employer?(*)
    Required Input
  11. Supervisor Name:(*)
    Required Input
  12. Supervisor Phone:(*)
    Include area code for example: 916-555-4422
  13.  
  1. Sierra Asphalt Inc. (the "Company") is an equal opportunity/affirmative action employer. All qualified applicants will be considered without regard to age,race, color, sex, religion, nation origin, marital status, ancestry, citizenship, veteran status, sexual orientation or preference, or physical or mental disability.

    Employment History - Employer #3


  2. Company Name:(*)
    Required Input
  3. Company City(*)
    Required Input
  4. Job Title:(*)
    Required Input
  5. Job Duties:(*)
    Required Input
  6. Start Date:(*)
    Required Input
  7. End Date:(*)
    Required Input
  8. Reason for leaving:(*)
    Required Input
  9. Ending Hourly Wage:
    Invalid Input
  10. May we contact this employer?(*)
    Required Input
  11. Supervisor Name:(*)
    Required Input
  12. Supervisor Phone:(*)
    Include area code for example: 916-555-4422
  13.  
  1. Certification and Authorization


    I authorize investigation of all statements contained herein and the employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have,personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

    I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act and other relevant Federal, State or Local laws.

    I hereby consent and agree that my driver's license information may be given to Sierra Asphalt Inc.'s insurance agent, Capitol Division of InterWest Insurance Services, Inc. A record will be obtained from the Department of Motor Vehicles for underwriting purposes for automobile insurance for Sierra Asphalt Inc. I hereby authorize Capitol Division of InterWest Insurance Services, Inc. to release my driving record to Sierra Asphalt Inc. Consent to be kept on record for five years after employment ceases.

    I understand that nothing in this employment application, the granting of an interview, or my subsequent employment with the Company is intended to create an employment contract between myself and the Company under which my employment could be terminated only for cause. On the contrary, I understand and agree that, if hired, my employment will be terminable "at will" and may be terminated by me or the Company at any time and for any reason. I understand that no person has the authority to enter into any agreement contrary to the foregoing.

    If employed, I understand I will be required to provide original documents verifying my identity and right to work in the United States under the Immigration Reform and Control Act of 1986. The documents provided will be used for completion of Form I-9.

3755 Omec Circle, Suite 2, Rancho Cordova, CA 95742 / (916) 635-9898
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