EMPLOYMENT APPLICATION

Wages starting at $25/hour, plus $1,000 Signing Bonus.

Horsley Specialties Inc. will be accepting and reviewing applications all year.

Please call us with any questions.

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Horsley Specialties, Inc. Application for Employment

We consider applicants for all positions without regard to race, color, creed, religion, national origin, gender, age, disability, marital or veteran status, sexual orientation or any other legally protected status.

Position applying for:

Date

Month

Day

Year

Location applying for:

What location are you applying for:

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Emergency contact name & phone number:

Emergency contact relationship:

Driver's license:

Class 1

Class 2

Class 3

Class A

Class B

Class C

Don't have one

Driver's license endorsements:

When will you be able to obtain a driver's license, if you don't have one?

Are you 18 years or older?

Yes

Work involves kneeling, lifting, bending, moving items 50+ lbs and other strenuous activities. Do you have any limitations that would prevent you from completing such tasks?

Yes

Have you ever filed an application with us before?

Yes

If so, when?

Are you currently employed?

Yes

May we contact your present employer?

Yes

Employer:

Employer phone:

What date would you be available to work?

Are you available to work full time or part time?

Part time

Full time

Are you currently on "lay-off" status and subject to recall?

Yes

Can you travel?

Yes

Have you been convicted of a felony in the last 10 years?

Yes

If yes, please explain:

(Conviction will not necessarily disqualify an application from employment.)

How did you hear about this position?

Indeed

Online

Job Service

Employee

Billboard

Social Media

Other

Employee Who Referred You

Education

High school:

Address:

Studies:

Years completed:

Received:

Diploma

Degree

College:

Address:

Studies:

Years completed:

Received:

Diploma

Degree

Other:

Address:

Studies:

Years completed:

Received:

Diploma

Degree

Foreign Languages:

Do you know any foreign languages?

Yes

If so, what language?

What would you rate your speaking skills?

Fluent

Good

Fair

What would you rate your reading skills?

Fluent

Good

Fair

What would you rate your writing skills?

Fluent

Good

Fair

Do you know any other foreign languages?

Yes

If so, what language?

What would you rate your speaking skills?

Fluent

Good

Fair

What would you rate your reading skills?

Fluent

Good

Fair

What would you rate your writing skills?

Fluent

Good

Fair

Describe any specialized training, apprenticeship, and skills you think would be beneficial:

Describe any job-related training received in the US Military:

Equipment Operated

Please select your skill level: 1-Never Used, 2-Little Skill, 3-Some Skill, 4-Well Skilled

Electric drill:

Tile stripper:

Chop saw:

Jackhammer:

Manometer:

Hammer:

Sawzall:

Buffer:

Skill saw:

Neg air:

Manual transmission:

Pulled trailer with truck:

Pickup:

Hydraulic jack:

Others used:

Carpentry/Construction Skills

Please select your skill level: 1-Never Used, 2-Little Skill, 3-Some Skill, 4-Well Skilled

Carpentry Skills:

Construction Skills:

Please list any carpentry skills that you think would help our crew in the field:

Asbestos/Lead Experience

Currently Licensed in what states:

Other Special Certifications such as Haz Mat?

Employment Experience

Start with your present employer or last employment.

Employer #1:

Address:

Phone:

Job title:

Supervisor:

Reason for leaving:

Date employed from:

Date employed to:

Starting rate/salary:

Final rate/salary:

Work performed:

Employer #2:

Address:

Phone:

Job title:

Supervisor:

Reason for leaving:

Date employed from:

Date employed to:

Starting rate/salary:

Final rate/salary:

Work performed:

Employer #3:

Address:

Phone:

Job title:

Supervisor:

Reason for leaving:

Date employed from:

Date employed to:

Starting rate/salary:

Final rate/salary:

Work performed:

Employer #4:

Address:

Phone:

Job title:

Supervisor:

Reason for leaving:

Date employed from:

Date employed to:

Starting rate/salary:

Final rate/salary:

Work performed:

References

Reference #1:

Phone:

Address:

Relationship:

Reference #2:

Phone:

Address:

Relationship:

Reference #3:

Phone:

Address:

Relationship:

Signature of applicant:

Typed name acts as signature:

Date

Month

Day

Year

HORSLEY SPECIALTIES, INC. INVITATION TO SELF-IDENTIFY

Horsley Specialties, Inc. is committed to providing equal opportunity in employment for all people without regard to race, color, religion, pregnancy, sex, national origin, age, disability, or other protected characteristic and to prohibiting discrimination in employment based on race, color, religion, pregnancy, sex, national origin, age, disability, or other protected characteristic. By hiring, compensating, training, promoting, and in all ways providing equal treatment to employees, the effectiveness of our operations can be maintained while enhancing the economic progress and growth of our employees. This company will assure that managers, supervisors, and all other employees at this establishment comply with both the letter and spirit of federal, state, and local legislation, government regulations, and executive orders in providing affirmative action and equal employment opportunity without regard to race, color, religion, national origin, age, disability, or history of disability (except where physical or mental abilities are a bona fide occupational requirement, and the individual is not able to perform the essential functions of the position even with reasonable accommodations), pregnancy, sex (unless gender is a bona fide occupational qualification), or any other protected characteristic.

Are you a Special Disabled Veteran?

Special Disabled Veteran means (i) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans’ Affairs for a disability (A) rated at 30 percent or more, or (B) rated at 10 or 20 percent in the case of a veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap or (ii) a person who was discharged or released from active duty because of a service-connected disability.

Yes

Are you a Veteran of the Vietnam-era?

Veteran of the Vietnam-era means a person who: (I) served on active duty in the U.S. military, ground, naval or air service for a period of more than 180 days, and who was discharged or released there from with other than a dishonorable discharge, if any part of such active duty was performed: (A) in the Republic of Vietnam between February 28, 1961 and May 7, 1975; or (B) between August 5, 1964 and May 7, 1975, in all other cases; or (ii) was discharged or released from active duty in the U.S. military, ground, naval or air service for a service-connected disability if any part of such active duty was performed (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in any other location.

Yes

Are you a Newly Separated Veteran?

Newly Separated Veterans means any veteran who served on active duty in the U.S. military, ground, naval or air service during the one-year period beginning on the date of such veteran’s discharge or release from active duty.

Yes

Are you an Other Protected Veteran?

Other Protected Veterans means veterans who served on active duty in the U.S. military, ground naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.

Yes

Race:

African American

American Indian

Asian

Caucasian

Hispanic

Other

EMPLOYMENT APPLICATION

Wages starting at $25/hour, plus $1,000 Signing Bonus.

Horsley Specialties Inc. will be accepting and reviewing applications all year.

Please call us with any questions.

Horsley Specialties, Inc. Application for Employment

Education

Foreign Languages:

Equipment Operated

Carpentry/Construction Skills

Asbestos/Lead Experience

Employment Experience

References

Signature of applicant:

HORSLEY SPECIALTIES, INC. INVITATION TO SELF-IDENTIFY

Asbestos Abatement

Asbestos Abatement

Concrete Grinding & Polishing

Concrete Grinding & Polishing

Flooring Removal

Flooring Removal

Mold Remediation

Mold Remediation

Lead Abatement

Lead Abatement

Other Services

Other Services

About

Rapid City Office

Fargo-Moorhead Office

EMPLOYMENT APPLICATION

Wages starting at $25/hour, plus $1,000 Signing Bonus.

Horsley Specialties Inc. will be accepting and reviewing applications all year.

Please call us with any questions.

Horsley Specialties, Inc. Application for Employment

Education

Foreign Languages:

Equipment Operated

Carpentry/Construction Skills

Asbestos/Lead Experience

Employment Experience

References

Signature of applicant:

HORSLEY SPECIALTIES, INC. INVITATION TO SELF-IDENTIFY

Asbestos Abatement

Asbestos Abatement

Concrete Grinding & Polishing

Concrete Grinding & Polishing

Flooring Removal

Flooring Removal

Mold Remediation

Mold Remediation

Lead Abatement

Lead Abatement

Other Services

Other Services

About

Rapid City Office

Fargo-Moorhead Office

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