Name
Address
City
State/Zip	MN WI AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY /
Phone
Email

Position You are Applying For:
Are you a Union Member?	Yes No
If so, which Union?

Education	Name and location of School	# of Yrs	*Graduate?	Subjects Studied
Grammar School			Yes No
High School			Yes No
College			Yes No
Trade, Business or Correspondence School			Yes No

* The age discrimination in Employment Act of 1967 prohibits discrimination on the basis
of age with respect to individuals who are at least 40 but less than 70 year of age.

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General
Subject of Special Study or Research Work
US Military or Navel Service	Yes No
Rank
Present membership in National Guard or Reserves

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Former Employers
Date, Month and Year		Name and Address of Employer	Salary	Position	Reason for Leaving
From To
From To
From To
From To

References
Give the names of three persons not related to you, whom you have known at least one year.

Name	Address	Business	Years Acquainted

In case of emergency notify (name)
(address)
(phone)
Have you ever been convicted of a crime, other than minor traffic offenses:
If so, please explain

note: A prior conviction will not necessarily bar you from employment; however the type of conviction and when it occurred will be considered.

Enter Any Additional Comments Below:

Certification
"I certify that the information in this application is true and understand that misrepresentations or false or omitted facts may result in my termination, regardless of the time of discovery by the company. I also understand, that, if hired, my employment is for no definite period and may be terminated at any time without written notice and that, absent a written contract signed by the President of the company, I will remain an at-will employee and can be terminated at any time without an notice.

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

I understand that if the company decides to engage an investigative consumer reporting agency to report on my credit and personal history, the company will provide me, at my request, with the name and address of the agency so that I can obtain from them the nature and substance of the information contained in the report.

Signature __________________________________________ Date________________

Mail To: Attn: Human Resources Enebak Construction Company PO Box 458 Northfield, MN

Fax To: Attn: Human Resources 507- 645-9569