9 Collan Park, Honesdale, PA 18431 ~ Phone: 570-253-4090 Fax: 570-253-4346

APPLICATION FOR EMPLOYMENT
An Equal Opportunity Employer
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Leeward Construction, Inc. is an equal opportunity employer. Employment decisions, including all hiring decisions, are made without regard to race, color, religion/creed, sex, national origin, ancestry, age, pregnancy, non-job-related disability, veteran status, possession of a General Education Development Certificate as compared to a high school diploma, or any other trait protected by applicable federal, state, or local laws. We strive to hire the hardest working and most qualified individuals.

Please complete the entire application truthfully. Even if you are attaching a resume, the entire application must be completed or it will not be considered. Any falsifications or omissions may be grounds for immediate dismissal. If a given question is not applicable to you, you should answer N/A. An incomplete application will not be accepted.

Last Name First Name Middle Initial

Address City State Zip Code

Home Phone Cell Phone: Email Address:

Position(s) Applied For Date You Can Start

Are you legally eligible for employment in the United States? Yes No

Do you have a valid driver's license? Yes No

Are you at least 18 years of age? Yes No
If you are not at least 18 years of age, how old are you?
If you are not at least 18 years of age, do you have valid working papers? Yes No

Have you ever filed an application with us before? Yes No If yes, give date

Have you ever been employed with us before? Yes No If yes, give date

Are you currently employed? Yes No If no, how long have you been unemployed?

Are you available for full time work? Yes No

Are you available to travel, via a method of transportation provided by you, to job sites within a 75 mile radius of Leeward's Corporate Office? Yes No

Are you able to perform all of the essential functions of the job that you have applied for
with or without a reasonable accommodation? Yes No

Have you ever been convicted of, or pled guilty to, any felony or misdemeanor crime? Yes No
If you answered yes above, please list all crimes which you have been convicted of or pled guilty to and include the date of offense. Please note that you will not automatically be excluded from consideration based upon a criminal record. Your suitability for the position sought will be evaluated based upon the circumstances in order to determine whether the criminal record renders you unsuitable for the job.

Have you been discharged or fired from any job that you have held within the past 10 years? Yes No
If you answered yes above, please describe the circumstances involved.

Please list the skills and/or qualifications which you feel would especially qualify you for the position for which you have applied.

Equipment Operators Only: Please enter the number of years of experience you have operating the following machinery:

Bulldozer yrs. Crane yrs. Loader yrs. Scraper yrs. Other: