• Trusted Rentals •
Job Application Form

Website | 300 John Stark Highway, Newport NH
Phone: (603) 763-1319
Questions? Please email or call Mike Butler at 603-306-4700.

Current Job Openings

Personal Information (Section 1)

First Name *	Last Name *
Street Address	Email Address *
Home Phone	Cell Phone

City

State

Zip Code

Employment Information (Section 2)

Desired Position *	Desired Wage *
Date Available to Begin Work
Available for full-time or part-time work? Full Time Part Time Either
Is there any information regarding your name, or use of another name that we will need to check on your work record. If so please specify:

Criminal Offenses (Section 3)

* Have you ever been convicted of a felony? If "yes", list where, for what and give dates. (include adjudications of guilt and pleas of no contest) Yes No

Employment Record (Section 4)

Please list your last three positions starting with your most recent.

COMPANY #1

Company Name	Phone
Location	Job Title
Description of Work Performed	Reason for Leaving
Supervisor's Name
Employed (month and year)
From	To
Start Salary	End Salary

COMPANY #2

Company Name	Phone
Location	Job Title
Description of Work Performed	Reason for Leaving
Supervisor's Name
Employed (month and year)
From	To
Start Salary	End Salary

COMPANY #3

Company Name	Phone
Location	Job Title
Description of Work Performed	Reason for Leaving
Supervisor's Name
Employed (month and year)
From	To
Start Salary	End Salary

Education (Section 5)

High School Name *	Grade Completed
Diploma
College or Trade School	Years Completed
Degree/Diploma
Other Training:
Licenses or Professional Certificates applicable to this position:

References (Section 6)

Reference #1

Reference Name*	Phone *
Profession	Relationship
Years Known

Reference #2

Reference Name	Phone
Profession	Relationship
Years Known

Reference #3

Reference Name	Phone
Profession	Relationship
Years Known
NOTE: We will contact all of the employers listed on this application unless you specifically exclude them below. Please list any employers you do not want us to contact and your reason for the exclusion:
Employer	Reason

Application Statement: I hereby certify that all responses set forth during my employment application process are true and complete. I authorize George M. Neuwirt Construction, LLC or its authorized agents to conduct a thorough investigation of all statements, written and oral, made by me during the entities connected with any such information request, including without limitation prior employers and law enforcement agencies, to provide any and all information and/or records they may have regarding my employment or me. I release and agree to indemnity George M. Neuwirt Construction, LLC, its authorized agents, and its employees, and all other persons, companies, and other entities from any and all liability arising out of such an investigation including, without limitation, any liability for furnishing information or for taking any action based on the information provided. I understand and agree that any falsification, misrepresentation, or omission, either on the employment application form or in my responses to questions asked during the interviewing or application process, may disqualify me from further consideration for employment, or if employed by George M. Neuwirt Construction, LLC, will subject me to immediate discharge whenever the falsification or omission is discovered. I understand that George M. Neuwirt Construction, LLC has a policy against the possession, use, sale or transfer of drugs or alcohol by its employment applicants or employees. I further understand that George M. Neuwirt Construction, LLC is committed to a drug-free workforce.
Applicant's Name*	Date