Rev. 4-13
SEWARD COUNTY BRIDGES
Today’s Date____________
An Equal Opportunity Employer*
Application for Employment
This application must be accompanied by a cover letter and resume and must be mailed, emailed, or hand
delivered to kjschildt@youraam.com; 521 First Street, PO Box 10, Milford, NE 68405. Applications
and resumes received after a specified closing date will not be considered.
Please Print or Type
Name
(Last)
(First)
(Full Middle Name)
Current Address
City
Home Phone Number
(
)
State
Alternative Contact Number
(
)
Zip Code
E-mail address
If no phone, how may we contact you?
What position are you applying for?
Wage desired
Date available for employment
Any restrictions on hours, weekends, or overtime? If yes, explain.
How were you referred? □ NEworks
□ Bridges Website □ Newspaper
□ Current employee: ________________ □ Personal referral: _______________ □ Other: _______________
Can you, upon employment,
Are you over
Have you ever been
Convictions will not automatically
submit verification of your
18 years old?
convicted of a felony?
disqualify job candidates. The
legal right to work in the
seriousness of the crime and date of
conviction will be considered.
United States? □ Yes □ No □ Yes □ No
□ Yes
□ No
PERFORMANCE OF JOB FUNCTIONS
Are you able to perform the essential functions of the job for which you are applying, with or without
accommodation?
□ Yes
□ No
EDUCATION
School Level
School Name, City, & State
No. of Years
Attended
Did You
Graduate?
Type of Degree
or Diploma
High School
College
Graduate
School
* EOE. Seward County Bridges prohibits discrimination, in its operation, on the basis of race, color, national origin, gender, religion, age, disability,
political beliefs, sexual orientation, marital or family status, or disabling condition in conformity with applicable laws.
EMPLOYMENT HISTORY
Are you employed now? □ Yes □ No
If so, may we inquire of your present employer? □ Yes
□ No
Have you ever been discharged from any employment or asked to resign? □ Yes
□ No
If yes, which employer and give explanation: __________________________________________________________
PAST EMPLOYERS: List below last three employers, starting with the most recent employer:
Position
Main Telephone # for Employer
( )
Name of Employer
Full Address (Including Street, City, State & Zip)
Kind of Business
Supervisor's Name, Title, & Phone #
Reason for Leaving
Dates Employed From (Month/Year)
To (Month/Year)
Wage
Describe the Work Performed
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Name of Employer
Position
Main Telephone # for Employer
( )
Full Address (Including Street, City, State & Zip)
Kind of Business
Supervisor's Name, Title, & Phone #
Reason for Leaving
Dates Employed From (Month/Year)
To (Month/Year)
Wage
Describe the Work Performed
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Name of Employer
Position
Main Telephone # for Employer
( )
Full Address (Including Street, City, State & Zip)
Kind of Business
Supervisor's Name, Title, & Phone #
Reason for Leaving
Dates Employed From (Month/Year)
To (Month/Year)
Wage
Describe the Work Performed
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
I certify that all the information submitted by me on this application is true and complete, and I understand that if any false
information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my
employment may be terminated at any time. In consideration of my employment, I agree to conform to Seward County Bridges’s
rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or
without notice, at any time, at either my or Seward County Bridge’s option. I also understand and agree that the terms and
conditions of my employment may be changed, with or without cause, and with or without notice, at any time by Seward County
Bridges.
I authorize investigation of all statements contained herein and release Seward Count Bridges y from all liability for any damage
that may result from utilization of such information.
DATE: __________________________
SIGNATURE: ___________________________________________
SEWARD COUNTY BRIDGES
CONSENT FOR RELEASE OF EMPLOYMENT HISTORY
INFORMATION
Seward County complies with Neb. Rev. Stat. § 48-201, the Job Reference Immunity Act. Failure
to sign and date the consent form may be considered in determining eligibility for employment.
I,_____________________________________, hereby give consent to any and
(PRINT NAME HERE)
all previous employers of mine to provide information with regard to my employment
with prior employers to SEWARD COUNTY BRIDGES.
I understand that this consent to release employment history shall remain in effect
for six (6) months from the date below unless earlier revoked by me. The revocation
shall be in writing, dated, and signed and shall be effective upon receipt by Seward
County BRIDGES.
Dated: __________________________, 2015
______________________________
Signature
Last updated 2015