Employment

Your Name:
Today's date:

Street Address:

City:  State:  Zip:

Phone#: Email:

What Position are you applying for/trade?
BricklayerFinisher49erLabor-MasonryLabor-ConcreteLabor-both

Union Status
Journey years at this position     Apprentice: years

Union #: or Non-Union:

Do you have any friends or relatives that works here? YesNo
List Name of Relative

I understand the job requires me to repeatedly: Kneel, squat, bend, twist, climb stairs, climb ladders and carry
loads of 65lbs. I am also expected to work in temperatures of extreme heat and cold. Can you perform the
requirements of this job without reasonable accommodation?YesNo
If no please explain:

(Optional)Race: WhiteBlackHispanicNative AmericanAsian/Pacific Islander

Sex: MaleFemale

Work History
Have you worked for Crosstown Masonry before?YesNo
When?

Job #1
Company:

From: To:

Job Duties:
Supervisor:  Phone:

Reason for Leaving:

Job #2
Company:

From:  To:

Job Duties:
Supervisor:  Phone:

Reason for Leaving:

Job #3
Company:

From: To:

Job Duties:
Supervisor:  Phone:

Reason for Leaving: