Zignego Company Application

Hidden

Date of Application

Personal Information

Name*

First Middle Last

Are you 18 years or older?*

Yes
No

Birth Date*

Social Security Number*

You MUST be 21 years or older to be eligible for a CDL required position.

Current Address*

Street Address City State ZIP

How many years have you lived at your current address?*

Cell Phone Number*

Home/Other Phone Number

Email Address*

Are you a U.S. citizen or otherwise currently authorized to obtain lawful employment in this country?*

Yes
No

Have you pleaded guilty to or been convicted of a misdemeanor or felony?*

If the job you are applying for requires you to operate a motor vehicle, include traffic convictions. (We will consider your record only as it may substantially relate to the job for which you are applying and this will not necessarily disqualify you).

Yes
No

Provide further information as to the offense(s), date, location, and so forth.*

Have you ever been known by another name that any reference, school, or previous employer may know you as? If so, what is/was this name?

Employment Desired

Location and type of work you are seeking?*

Work OUTSIDE the state of Wisconsin
Work ONLY in the Madison/Milwaukee/Racine areas
Work on one of our construction ROAD CREWS or main shop/office in Wisconsin

Your application will be directed to Z Mix USA

Your application will be directed to Zignego Ready Mix

Your application will be directed to Zignego Company, Inc.

Do you currently hold a VALID commercial driver’s license (CDL) with air brake endorsements?*

Yes
No

A CDL is required for employment with Z Mix USA.

A CDL is required for employment with Zignego Ready Mix.

Do you wish to work full-time seasonally (March-November) or have the ability to work year-round?*

Seasonally
Year Round

Employment at Z Mix USA is only on a full-time seasonal basis (March - November).

Employment at Zignego Company, Inc. is only on a full-time seasonal basis (March - November).

Position Applied For*

Identify "Other Position"*

Salary/Hourly Rate

Date You Can Start*

Have you ever applied to this company before?*

Yes
No

Season previously applied*

Year previously applied*

Education and Training

This information will be used only where relevant and to assist in determining what positions might be appropriate for consideration.

High School

Name and Location of School	Number of years attended	Graduate?

College

Name and Location of School	Number of years attended	Graduate?	Subject Studied/Degree

Technical/Trade School

Name and Location of School	Number of years attended	Graduate?	Subject Studied/Degree

Describe any other training received or apprenticeship programs that you consider relevant for the position for which you are applying.

List any construction equipment, machines, tools, etc. that you can operate or if relevant, that you can repair/perform maintenance on.

Driving Qualifications and Experience

If the job desired requires the use of a motor vehicle, do you have a valid Wisconsin driver's license?*

Yes
No

If the job desired requires the use of a commercial driver's license, do you have a valid Commercial Drivers License?*

Yes
No

A Commercial Drives License is required for a CDL position.

Drivers License Information*

State	License Number	Type	Expiration Date (mm/dd/yyyy)

Upload a photo of your Driver's License - Front*

Max. file size: 50 MB.

Upload a photo of your Driver's License - Back*

Max. file size: 50 MB.

Employment Record

Provide complete information. Be Specific. START WITH YOUR CURRENT or most recent job. Include self-employment and military services. For part-time work, show the average number of hours per month. Show any changes in job title for the same employer as a separate position.

Are you currently employed?*

Yes
No

May we contact your current employer?*

Yes
No

Current/Most Recent Previous Employer
Employer Name
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Name of Supervisor
Phone
Position Held
Last Pay Rate
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Duties
Reason for leaving

Do you need to add a second previous employer?*

Yes
No

Second Most Recent Previous Employer
Employer Name
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Name of Supervisor
Phone
Position Held
Last Pay Rate
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Duties
Reason for leaving

Do you need to add a third previous employer?*

Yes
No

Third Most Recent Previous Employer
Employer Name
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Name of Supervisor
Phone
Position Held
Last Pay Rate
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Duties
Reason for leaving

Do you need to add a fourth previous employer?*

Yes
No

Fourth Most Recent Previous Employer
Employer Name
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Name of Supervisor
Phone
Position Held
Last Pay Rate
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Duties
Reason for leaving

Do you need to add a fifth previous employer?*

Yes
No

Fifth Most Recent Previous Employer
Employer Name
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Name of Supervisor
Phone
Position Held
Last Pay Rate
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Duties
Reason for leaving

Do you need to add any additional employment history?*

Yes
No

Enter additional Employment History.

References

Personal References

List at least three personal references that are not related to you.

Name	City, State	Phone Number	Years Acquainted

Authorization, Release, and Certification by Applicant

I CERTIFY THAT ALL INFORMATION ON THIS APPLICATION IS TRUE, COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT ANY FALSE OR MISLEADING STATEMENTS BY ME MAY RESULT IN REJECTION OF MY APPLICATION, OR, IF EMPLOYED, MY IMMEDIATE DISMISSAL.

I HEREBY GIVE PERMISSION OF TO THE EMPLOYER TO SEEK TO VERIFY AND SUPPLEMENT THE INFORMATION SET FORTH IN THE APPLICATION. I RELEASE FROM ALL LIABILITY OR LEGAL CLAIMS EVERY PERSON SEEKING OR PROVIDING INFORMATION, WHETHER ORAL OR WRITTEN. A PHOTOCOPY OF THIS RELEASE SHALL BE AS VALID AS THE ORIGINAL AND MAY BE RELIED UPON BY ALL PERSONS PROVIDING INFORMATION.

I UNDERSTAND THAT EMPLOYMENT WITH THIS EMPLOYER IS NOT CONTRACTUAL AND IS AT-WILL. I UNDERSTAND AND AGREE THAT, IF HIRED, I MAY VOLUNTARILY LEAVE EMPLOYMENT AT ANY TIME, AND MAY BE TERMINATED AT ANY TIME WITHOUT PRIOR NOTICE FOR ANY REASON, OR FOR NO REASON. I UNDERSTAND THAT ANY ORAL OR WRITTEN STATEMENTS WHICH I MAY CLAIM TO HAVE BEEN MADE TO ME NOW OR IN THE FUTURE INCONSISTENT WITH THE PROVISIONS OF THIS PARAGRAPH, ARE EXPRESSLY DISAVOWED AND REVOKED BY THE COMPANY, AND SHOULD NOT BE RELIED UPON BY ME AS AN APPLICANT FOR EMPLOYMENT OR AS AN EMPLOYEE IF HIRED.

I UNDERSTAND THIS APPLICATION WILL BE CONSIDERED INACTIVE AFTER 30 DAYS.
I UNDERSTAND THAT IF MY APPLICATION IS ACCEPTED AND I AM OFFERED EMPLOYMENT, THE EMPLOYER MAY CONDITION EMPLOYMENT UPON THE SUCCESSFUL COMPLETION OF A PHYSICAL OR MEDICAL EXAM.
I CERTIFY I HAVE READ (OR HAVE HAD READ TO ME) AND UNDERSTAND THIS AUTHORIZATION, RELEASE, AND CERTIFICATION.

Type your name as acceptance.*

What is 6 + 2?*