201 Briar Hill Road, Lititz, PA 17543
Mon - Fri 9:00am - 5:00pm
Affordable Paving is an equal opportunity employer which does not discriminate in hiring or employment. No question on this application is intended to secure information to be used for such discrimination.
Are you at least 18 years of age? *
First Name *
Last Name *
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Zip Code *
Phone Number *
Alternate Phone Number
Your Email *
If an offer is made, will you be able to show proof of eligibility to work under the citizenship and immigration laws? *
Position applying for: *
Laborer Equipment Operator Equipment Repair & Maint. Driver Other
Have you previously filed an application with Affordable Paving? *
If yes, when and what position?
If an offer is made, when can you start?
Hours you are able to work: * Temp Part-Time Full-Time Saturdays
Have you ever been convicted or placed on probation for a felony? *
If you answered “Yes,” please give details:
High School Name:
High School Address:
Achieved GED? *
College School Name:
College School Address:
Type of Degree:
Other School Name:
Other School Address:
List any experience or skills that you feel qualify you for the position(s) that you are seeking:
If presently employed, why are you seeking other employment?
Provide the following information on your current and past employers for the last 5 years. Explain any gaps in employment in the comment section below.
Reason for Leaving:
Supervisor's Phone Number
Employer 2 Name:
Employer 2 Address:
Title/Position Held 2:
Start Date 2
End Date 2
Ending Salary 2:
Key Responsibilities 2:
Reason for Leaving 2:
Supervisor 2's Name:
Supervisor 2's Phone Number
Employer 3 Name:
Employer 3 Address:
Title/Position Held 3:
Start Date 3
End Date 3
Ending Salary 3:
Key Responsibilities 3:
Reason for Leaving 3:
Supervisor 3's Name:
Supervisor 3's Phone Number
Please explain any gaps in employment:
Please provide three work references that are not relatives. If no work references are available, list three school or personal references that are not relatives.
Referral 1 Name:
Referral 1 Title/Position:
Referral 1's Phone Number
Referral 1 Years Known:
Referral 2 Name:
Referral 2 Title/Position:
Referral 2's Phone Number
Referral 2 Years Known:
Referral 3 Name:
Referral 3 Title/Position:
Referral 3's Phone Number
Referral 3 Years Known:
Field and equipment positions at Affordable Paving have physical requirements as follows. If you are applying for one of these positions, please answer the following questions.
Are you able to lift 90 pounds up to 10 times per day, with or without accommodation? *
Can you bend, stretch, reach, climb and stand throughout an 8-10 hour period, with or without accommodation? *
If driving or operating equipment, can you sit for extended periods of time and climb in and out of a cab, with or without accommodation? *
Can you work outside in variable as well as extreme hot and/or cold working conditions, with or without accommodation? *
I understand that if I am offered employment with Affordable Paving a drug screen for illegal / controlled substances may be required.
I further authorize schools, references, former employers, and physicians or other medical practitioners to provide my record, reason for leaving employment, and all other job-related information they may have concerning me to the Company, and I release and hold harmless all parties providing job-related information from any and all liability or claims for damages that may result from this job-related information’s release, disclosure and use. I understand that unfavorable information Affordable Paving discovers as a result of this investigation may prevent my being hired, or if hired, may subject me to immediate dismissal.
I certify that the information contained in this application is correct to the best of my knowledge and understanding. I agree to conform to the Company’s rules and regulations, and as an at-will employee my employment and compensation can be terminated at any time with or without notice by either the Company or me.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Your Full Name (Digital Signature) *