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Employment Form

4636 Shuster Road, Columbus, Ohio 43214
(614) 451-2242

Employment Application

(* Required field)


Personal Data

First Name*
Middle Name*
Last Name*
Email*
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.?
  •      
  • 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:
    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
  • Local & type of trade:
    City/State:


    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
  • 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?


    Signature

    Please read carefully before submitting.

    Applicants Authoriztion: I hereby voluntarily authorize Nickolas Savko & Sons 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. I understand that Nickolas Savko & Sons 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 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, 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 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, Inc. regardless of when the false information or omission is discovered. Once you are hired at Savko you can not have or maintain any other employment.

         

    To the best of my knowledge I have provided true and accurate information.

    Submitted by: (please type your full name.)*
    Nickolas Savko & Sons, Inc. is an Equal Opportunity Employer. Nickolas Savko & Sons, Inc. does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state or federal law.
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    Nickolas Savko & Sons, Inc. | 4636 Shuster Road, Columbus, Ohio 43214 | 614-451-2242
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