5875 S. State Route 48 Maineville, OH 45039 (513) 683-2442
Premier Curb of Cincinnati, in accordance with state and federal laws, is an equal opportunity employer and does not discriminate on the basis of age, race, sex, religion, color, nation origin, physical or mental disability, or ancestry. All applicants who receive job offers are required to undergo drug testing. ALL OFFERS OF EMPLOYMENT WILL BE CONDITIONED ON THE RESULTS OF THESE TESTS.
Name: Name:
Address: Address:
City: City:
State: Select StateAL - AlabamaAK - AlaskaAZ - ArizonaAR - ArkansasCA - CaliforniaCO - ColoradoCT - ConnecticutDE - DelawareDC - District Of ColumbiaFL - FloridaGA - GeorgiaHI - HawaiiID - IdahoIL - IllinoisIN - IndianaIA - IowaKS - KansasKY - KentuckyLA - LouisianaME - MaineMD - MarylandMA - MassachusettsMI - MichiganMN - MinnesotaMS - MississippiMO - MissouriMT - MontanaNE - NebraskaNV - NevadaNH - New HampshireNJ - New JerseyNM - New MexicoNY - New YorkNC - North CarolinaND - North DakotaOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaPR - Puerto RicoRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVT - VermontVA - VirginiaWA - WashingtonWV - West VirginiaWI - WisconsinWY - Wyoming
Zip: Zip:
Phone Number: Phone Number
Phone Number Type Cell Home Work
Alt. Phone Number : Alt. Phone Number
Alt. Phone Number Type Cell Home Work
Email Address: Email Address
Are You a U.S. Citizen? Are You a U.S. Citizen?: no yes
If No, are you authorized to work in this country? If No, are you authorized to work in this country?: no yes
Have You Ever Been Convicted of a Felony? Have You Ever Been Convicted of a Felony?: no yes
Have you ever worked for this company? Have you ever worked for this company?: no yes
What experiences or skills qualify you to work here?: What experiences or skills qualify you to work here?
If Selected for Employment Are You Willing to Submit to a Pre-Employment Drug Screening Test? If Selected for Employment Are You Willing to Submit to a Pre-Employment Drug Screening Test?: no yes
Position You Are Applying For: Position You Are Applying ForForemanPipelayerLaborerOperatorConcrete FinisherConcrete LaborerOffice StaffMechanic
Available Start Date: Available Start Date
Desired Pay: Desired Pay:
The normal working hours of the company vary, including Saturdays. Are you available to work during these times? The normal working hours of the company vary, including Saturdays. Are you available to work during these times?: no yes
School Name: School Name:
Location: Location:
Years Attended: Years Attended:
Degree Received?: Degree Received?:
Major: Major:
Relationship: Relationship:
Years Known: Years Known:
Phone: Phone
Can we contact them for reference? Can we contact them for reference?: no yes
Phone: Phone:
Employer (1): Employer (1):
Job Title: Job Title:
Dates Employed: Dates Employed:
Work Phone: Work Phone
Reason For Leaving: Reason For Leaving:
Ending Pay Rate: Ending Pay Rate:
Employer (2): Employer (2):
Employer (3): Employer (3):
Employer (4): Employer (4):
If you are applying for an operator or labor position, please rate yourself in each category that follows the trade in which you are skilled. Please rate yourself with a number 1-5 that best describes your experience and skill level.
1 = No Experience 2 = Some Experience 3 = Average 4 = Above Average 5 = Excellent
D6 size and up Dozer D6 size and up Dozer: 1 2 3 4 5
D6 size and smaller Dozer D6 size and smaller Dozer: 1 2 3 4 5
GPS Machine Control on Dozer, Grader, etc. GPS Machine Control on Dozer, Grader, etc.: 1 2 3 4 5
Track Loader (Grading) Track Loader (Grading): 1 2 3 4 5
Excavator (Loading Trucks) Excavator (Loading Trucks): 1 2 3 4 5
627 Scraper 627 Scraper: 1 2 3 4 5
Tractor & Pull Pan Scraper Tractor & Pull Pan Scraper: 1 2 3 4 5
Off Road Truck Off Road Truck: 1 2 3 4 5
Sheepsfoot Compactor Sheepsfoot Compactor : 1 2 3 4 5
Tractor with Disc or Grade Box Tractor with Disc or Grade Box: 1 2 3 4 5
Soil Stabilizer Soil Stabilizer: 1 2 3 4 5
Motor Grader Motor Grader: 1 2 3 4 5
Track Excavator (Digging Pipe Trench) Track Excavator (Digging Pipe Trench): 1 2 3 4 5
Track Loader (Backfill Ditches) Track Loader (Backfill Ditches): 1 2 3 4 5
Vibratory Sheepsfoot Compactor Vibratory Sheepsfoot Compactor: 1 2 3 4 5
Wheel Loader Wheel Loader: 1 2 3 4 5
Trencher Trencher: 1 2 3 4 5
Directional Boring Machine Directional Boring Machine: 1 2 3 4 5
Curb Machine Curb Machine: 1 2 3 4 5
Skid Steer Skid Steer: 1 2 3 4 5
Mini-Hoe Mini-Hoe: 1 2 3 4 5
Rubber Tire Backhoe Rubber Tire Backhoe: 1 2 3 4 5
Shovel Shovel: 1 2 3 4 5
Carry/ Lift Heavy Objects Carry/ Lift Heavy Objects: 1 2 3 4 5
Jack Hammer Jack Hammer: 1 2 3 4 5
Set Up Pipe Laser Set Up Pipe Laser: 1 2 3 4 5
Set Up Line Transit Set Up Line Transit: 1 2 3 4 5
Pipe Layer Pipe Layer: 1 2 3 4 5
Water Tap Installation Water Tap Installation: 1 2 3 4 5
Shovel / Rake Concrete Shovel / Rake Concrete: 1 2 3 4 5
Finish Curb Finish Curb: 1 2 3 4 5
Finish Flatwork Finish Flatwork: 1 2 3 4 5
Curb / Flatwork Forming Curb / Flatwork Forming: 1 2 3 4 5
Wall Forming (Panels) Wall Forming (Panels): 1 2 3 4 5
Steel Tying for Reinforced Concrete Steel Tying for Reinforced Concrete: 1 2 3 4 5
G.P.S. Rover Unit and/or Base Station Set up G.P.S. Rover Unit and/or Base Station Set up: 1 2 3 4 5
Grade Checking Grade Checking: 1 2 3 4 5
Set Grade Stakes Set Grade Stakes: 1 2 3 4 5
Heavy Equipment Mechanic Heavy Equipment Mechanic: 1 2 3 4 5
Automobile / Truck Mechanic Automobile / Truck Mechanic: 1 2 3 4 5
Hydraulic Systems Repair Hydraulic Systems Repair: 1 2 3 4 5
Diesel Engine Repair Diesel Engine Repair: 1 2 3 4 5
Field Mechanic Abilities Field Mechanic Abilities: 1 2 3 4 5
Welding Welding: 1 2 3 4 5
Class A Class A: 1 2 3 4 5
Class B Class B: 1 2 3 4 5
Use a Manual Transmission Use a Manual Transmission: 1 2 3 4 5
Pull a Fifth Wheel Trailer Pull a Fifth Wheel Trailer: 1 2 3 4 5
Operate a Truck with Air Brakes Operate a Truck with Air Brakes: 1 2 3 4 5
Move Equipment with a Dump Truck and Pintle Trailer Move Equipment with a Dump Truck and Pintle Trailer: 1 2 3 4 5
Move Equipment with a Low Boy Trailer Move Equipment with a Low Boy Trailer: 1 2 3 4 5
Haul Material with a Dump Truck Haul Material with a Dump Truck: 1 2 3 4 5
Use a Truck Mounted Crane Use a Truck Mounted Crane: 1 2 3 4 5
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. As a condition of employment, I understand that Premier Curb of Cincinnati reserves the right to completely investigate and verify all information contained in this application. I agree to indemnify and save harmless Premier Curb of Cincinnati from and against any liabilities, claims, attorney fees, costs, causes of action, or other liability arising directly or indirectly from, or associated with this employment application. I agree to conform to the rules and regulations of Premier Curb of Cincinnati, and I understand that, if hired, my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either Premier Curb of Cincinnati or myself.
Signature: Signature:
April 16, 2024
