SAVKO

Applicants Authoriztion: I hereby voluntarily authorize Nickolas Savko & Sons and affiliated companies to obtain consumer reports about me from any consumer reporting agency and to consider the consumer reports when making decisions regarding my employment at Nickolas Savko & Sons and affiliated companies. I understand that Nickolas Savko & Sons and affiliated companies may contact the past employers and/or personal references I have provided in order to verify my past employment and work record. I authorize all past employers, educational institutions, government agencies and/or personal references to release any all information concerning my past employment work history, performance and personal character. Ihere by release all such past employers, personal references and Nickolas Savko & Sons and affiliated companies from any all liability resulting from damages I may incur in the reference verification process. I also understand that if employed by Nickolas Savko & Sons and affiliated companies, my employment is “at will” and can be terminated at any time for any reason either by myself or theCompany. This agreement cannot be modified by any representative of the Company either in writing or verbally. Finally, I understand it is unlawful for Nickolas Savko & Sons and affiliated companies to employ any one who is neither a citizen of the U.S. nor an authorized resident alien. I certify that the U.S. citizenship information I have provided the Company is authentic. Further, I certify that all information I have provided on this application is accurate. False information or omission off acts on the application will result in the termination of my employment with Nickolas Savko & Sons and affiliated companies, Inc. regardless of when the false information or omission is discovered. Once you are hired at Savko or affiliated companies you can not have or maintain any other employment.

4636 Shuster Road, Columbus, Ohio 43214 (614) 451-2242
Employment Application
(* Required field)

Personal Data
First Name*	Middle Name*
Last Name*
Address *	Address 2
City *	State* Zip*
Home Phone *	Mobile Phone
Are you a citizen of the U.S. or do you have a legal right to work in U.S.? Yes No Any offer of employment is conditioned upon completing form I-9 and providing documents establishing identity and work authorization.
Emergency Contact*	Phone Number*
Do you have a valid driver's license? Yes No
State Issued in:	Citations and Points:

Do you have a current personal automobile liability insurance coverage per Ohio laws? Yes No
With who:
Do you have a CDL license? Yes No	Type:
Endorsement:	What type of dependable transportation do you own: Type & Make of your car:
Have you ever plead guilty, no contest, and/or been convicted of a felony? Yes No Indicating 'yes' will not eliminate you from employment consideration.

Year	Nature & Disposition of Conviction:	Where (Location)

Are you currently part time or full time employed anywhere else? Yes No
Plan to be: Yes No
Doing what type of work:		Current workshift hours:


Educational Data
High School
Name	Address of School
Graduated? Yes No	Date degree conferred
College/Other
Name	Address of School
Date attended (from & to)	Graduated? Yes No
Major	Minor
Date degree conferred
Are you presently enrolled in school? Yes No	If yes, where enrolled?
List states and counties of residence for the past few years:
Have you used any other name other than names listed? Yes No
If so, please list:


Employment History
List all present and past employment, beginning with your most recent. Please attach additional sheets if necessary.
Employer 1
Name of Company	Location (City, State, Zip)
Phone Number	Supervisors Name
Employment Dates (Mo/Yr - Mo/Yr)
Starting Wage or salary	Ending Wage or salary
Reason for leaving?
Describe your duties:
Company benefits (health, dental, vision, prescription drug coverages); also list 401k, profit sharing, use of company vehicle, cell phone, etc.:
Was part or all the cost for your 'Company Benefits' deducted from your weekly paycheck?
Employer 2
Name of Company	Location (City, State, Zip)
Phone Number	Supervisors Name
Employment Dates (Mo/Yr - Mo/Yr)
Starting Wage or salary	Ending Wage or salary
Reason for leaving?
Describe your duties:
Company benefits (health, dental, vision, prescription drug coverages); also list 401k, profit sharing, use of company vehicle, cell phone, etc.:
Was part or all the cost for your 'Company Benefits' deducted from your weekly paycheck?
Employer 3
Name of Company	Location (City, State, Zip)
Phone Number	Supervisors Name
Employment Dates (Mo/Yr - Mo/Yr)
Starting Wage or salary	Ending Wage or salary
Reason for leaving?
Describe your duties:
Company benefits (health, dental, vision, prescription drug coverages); also list 401k, profit sharing, use of company vehicle, cell phone, etc.:
Was part or all the cost for your 'Company Benefits' deducted from your weekly paycheck?

Type of position(s) applying for: Equipment Operator Concrete Finisher Pipe Layer Laborer Sewer/Water Laborer Fuel & Lube Person Mechanic Supervision Truck driver Management/Secretarial
Please list in brief the experience you have for the type of position(s) you are applying:
Member of any affiliation to any organizational labor? Yes No

Employment Application

Personal Data

Educational Data

Employment History

Signature