Are you a US Citizen or have a legal permit to work in the US? YESNO
***Must have on file in order to ever drive company vehicles: I hereby grant permission for the Company's Insurance Company and Keller L.L.C dba/Keller Construction to secure a Motor Vehicle Report on me for the purposes of employment or yearly, for annual insurance renewals. I also affirm that the statements made above are stated truthfully and without reservation. Signed this on
YESNO Are you bondable:YESNO Ask if you are not sure.
List all Work History (Construction or not) for the last 3 years (Include Employer’s name and phone numbers if you can):
I the undersigned, certify that I am in good health and physical condition for the job I am applying. I do not have any preexisting or outstanding medical conditions, and I am not hiding any medical or physical problem that I am aware of. I do not have or know of any medical or physical problem I have now or have had that is still existing that could cause a safety issue, cause me physical harm or cause further medical problems when performing the work I have applied for. I also affirm that the statements made above are stated truthfully and without reservation. Signed this on:
Please give us at least 2 personal references we can contact about prior experience: