Employment Application - Leeward Construction, Inc.

Step 1 of 5

CURRENT EMPLOYMENT
Employer's name*
Date From – To*
May we contact your present employer?*
- Yes
- No
Current rate of pay*
Immediate supervisor*
Employer's address*
Street Address City State ZIP Code
Phone*
Description of current positon and job duties*
Has your employer taken any disciplinary action against you within the last two years?*
- Yes
- No
If yes, explain the discipline and the reasons in detail.
EDUCATION
High School*
Number of years completed*
University/college/trade school
Number of years completed
Major/Degree
Other education

FORMER EMPLOYERS (List below your last four employers; do not skip any employers.)
Name, Address & Phone Number*
Name of Supervisor*
Date From – To*
Salary or wage*
Description of Job*
Reason for Leaving*
Name, Address & Phone Number
Name of Supervisor
Date From – To
Salary or wage
Description of Job
Reason for Leaving
Name, Address & Phone Number
Name of Supervisor
Date From – To
Salary or wage
Description of Job
Reason for Leaving
Name, Address & Phone Number
Name of Supervisor
Date From – To
Salary or wage
Description of Job
Reason for Leaving
MILITARY SERVICE
Branch of Service
Period of Active Duty (From – To)
Date of Final Discharge
Rank of Discharge
REFERENCES (List three persons not related to you, whom you have known at least one year.)
Name*
Business
Phone Number
Address*
Years Acquainted*
Name*
Phone Number
Business
Address*
Years Acquainted*
Name*
Business
Phone Number
Address*
Years Acquainted*
Name*
Business
Phone Number
Address*
Years Acquainted*

239 Golf Hill Road
Honesdale, PA 18431
Mon-Fri: 7:30am – 4:00pm

Phone: 570-253-4090
Fax: 570-253-4346
Estimating Fax: 570-253-4581

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Leeward Construction, Inc. is an Equal Opportunity/Affirmative Action Employer.

LOCATION:
Scranton, PA

OWNER:
Niagara Bottling Company

CONTRACT AMOUNT:
$12.4 Million

DATE OF COMPLETION:
6/28/2022

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Step 1 of 5

CURRENT EMPLOYMENT

EDUCATION

FORMER EMPLOYERS (List below your last four employers; do not skip any employers.)

MILITARY SERVICE

REFERENCES (List three persons not related to you, whom you have known at least one year.)

APPLICANT’S AUTHORIZATION AND CERTIFICATION PLEASE READ CAREFULLY

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