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EZ Grout Corporation

1833 North Riverview Road
Malta, Ohio 43758
740-749-3512

THERE WILL BE A MANDATORY DRUG TEST BEFORE HIRING
BASED ON THE SAFETY REQUIREMENTS OF THE JOB, YOU MUST BE 18 YEARS OLD

Equal Opportunity Employer

Do you have any OSHA training?

YesNo

If yes, please circle which:

10 hr30 hr

If yes, which one(s) and please describe your experience:

Do you know anyone that works for Lang Masonry Contractors, Inc., Wolf Creek Contracting, LLC., or EZ Grout Corporation?

YesNo

Have you ever filled out an application with us before:

YesNo

If yes, give date:

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?

YesNo

(Proof of citizenship status will be required upon employment)

(Conviction will not necessarily disqualify an applicant from employment)
State any additional information you feel may be helpful to us in considering your application

EZ Grout Corporation requires drug-testing prior to hiring. Random testing is routinely conducted thereafter.
I,

verify that the statements that are made in this application are true and complete. I understand that if I am hired, any false or incomplete statement will be grounds for immediate dismissal.

Applicant Signature:

Date:

What is the most important feature to you in a job?

What do you like best about your present or previous job?

What do you like least about your present or previous job?

Why did you accept your present or previous job?

Please rank the following from most to least important: (Number 1 to 5, with 1 being most important)

a. Distance from work

b. Hours

c. Job duties

d. Pay

e. Work environment

What is the most important feature you look for in a supervisor?

How did you find out about this job?

REFERENCES

EMPLOYMENT EXPERIENCE

Employer Name

Address

Telephone #

Job Title

Supervisor

Work Performed

Dates employed: From

Hourly Rate / Salary: Starting

Final

Reason(s) for leaving

Employer Name

Address

Telephone #

Job Title

Supervisor

Work Performed

Dates employed: From

Hourly Rate / Salary: Starting

Final

Reason(s) for leaving

Employer Name

Address

Telephone #

Job Title

Supervisor

Work Performed

Dates employed: From

Hourly Rate / Salary: Starting

Final

Reason(s) for leaving

PLEASE FILL OUT FORM

AUTHORIZATION FORM

authorize EZ Grout Corporation, to obtain information about me from my previous employer, school(s). I also authorize my previous employer(s) and school(s) that I have attended, to disclose such information about me to the above listed company as they may request.

Dated this:

day of

Applicant Signature

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EZ Grout Corporation

Equal Opportunity Employer

REFERENCES

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