EMPLOYMENT APPLICATION
Please complete the entire application.
It is the policy of Julian M. Johnson Construction Corp. to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.

1. Employer Information
Employer: Julian M. Johnson Construction Corp.
Address: 6191 140th Avenue NW
City/State/ZIP: Ramsey, Minnesota 55303
Telephone: (763) 323-2900
2. Applicant Information
Applicant Full Name: ___________________________________________
Home Address: ___________________________________________
City/State/ZIP: ___________________________________________
Number of years at this address: _________
Daytime phone: ____________________ Evening phone: ____________________
Mobile phone: ____________________
Driver's License (State/Number): ___________________________
3. Emergency Contact: Who should be contacted if you are involved in an emergency?
Contact Name: ___________________________________________
Relationship to you: ___________________________________________
Address: ___________________________________________
City/State/ZIP: ___________________________________________
Daytime phone: ____________________ Evening phone: ____________________
4. Job Position Applied For:____________________________________
Full or Part Time? ____________________________________
5. Salary Desired: $ ____________ per _______________________________________________
6. Who referred you to our company? ______________________________________
Do you have any friends or relatives who work here? If yes, please list here:
___________________________________________________________
7. Are you at least 18 years old? ______ Yes ______ No
8. How will you get to work?_____________________________________
9. If applicable, are you available to work overtime? _____ Yes _____ No
10. If you are offered employment, when would you be available to begin work?
11. If hired, are you able to submit proof that you are legally eligible for
employment in the United States? _____ Yes _____ No
12. Applicant's Skills
List any skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.) List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.                             Skill_______________________                                                                              Years of Experience_____ Ability or Rating 1 2 3 4 5               Skill_______________________                                                                              Years of Experience_____ Ability or Rating 1 2 3 4 5
13. Applicant Employment History
Employer Name: ___________________________________________
Supervisor Name: ___________________________________________
Address: ___________________________________________
City/State/ZIP: ___________________________________________
Job Duties: ___________________________________________
Reason for Leaving: ___________________________________________
Dates of Employment (Month/Year): _____________________________
Employer Name: ___________________________________________
Supervisor Name: ___________________________________________
Address: ___________________________________________
City/State/ZIP: ___________________________________________
Job Duties: ___________________________________________
Reason for Leaving: ___________________________________________
Dates of Employment (Month/Year): _____________________________
Employer Name: ___________________________________________
Supervisor Name: ___________________________________________
Address: ___________________________________________
City/State/ZIP: ___________________________________________
Job Duties: ___________________________________________
Reason for Leaving: ___________________________________________
Dates of Employment (Month/Year): _____________________________
14. Applicant's Education and Training                                                           College/University Name and Address
____________________________________________________________     Did you receive a degree? ______ Yes _____ No                                                           If yes, degree(s) received:___________
High School/GED Name and Address
____________________________________________________________   Did you receive a degree? ______ Yes _____ No
Other Training (graduate, technical, vocational):
____________________________________________________________
Please indicate any current professional licenses or certifications that you hold:
____________________________________________________________
Awards, Honors, Special Achievements:
____________________________________________________________
15. References                                                                                                                    List any two non-relatives who would be willing to provide a reference for you.
Name: ___________________________________
Address: ___________________________________
City/State/ZIP: ___________________________________
Telephone: _______________________
Relationship: _______________________
Name: ___________________________________
Address: ___________________________________
City/State/ZIP: ___________________________________
Telephone: _______________________
Relationship: _______________________
16. Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:
____________________________________________________________
____________________________________________________________  CERTIFICATION
I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.
I authorize Julian M. Johnson Construction Corp. to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. If an employment relationship is created, I understand that unless I am offered a specific written
contract of employment signed on behalf of the organization by its President, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Julian M. Johnson Construction Corp., except in a specific written contract of employment signed on behalf of the organization by its President, has the power to alter or vary the voluntary nature of the employment relationship.
I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND
AND AGREE TO ITS TERMS.
____________________________________ _______________
APPLICANT SIGNATURE                                        DATE