Employment Application

Date *

Month

Day

Year

First Name *

Last Name *

Address *

State *

Zip Code *

Cell Phone #: *

Email Address *

Driver's License #: *

State Issued: *

Valid Drivers License? *

Yes

No

Position Applying for: *

Construction Laborer

Scale Technician

Other

What date are you available to start working for PSS? *

Month

Day

Year

If you're a student, when do you return to classes?

Month

Day

Year

Are you at least 18 years of age or older? *

Yes

No

Are you able to lift heavy objects? *

Yes

No

Restrictions

If you have physical restrictions, please explain

Do you have construction, mechanical or electrical/electronic experience? *

Yes

No

If yes, please explain

Have you ever been disciplined or fired by another company? *

Yes

No

If yes, please explain

Have you been convicted of a crime in the past 10 years? *

Yes

No

If yes, please explain

Select the highest level of education you have completed: *

Select the highest level of college education you have completed: *

List any friends or relatives that work or have worked for Prairie Scale Systems, Inc.

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