Job Application

Application For Employment

Kelsey Construction, LLC provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, parental status, national origin, age, disability, family medical history or genetic information. In addition to federal law requirements, we comply with applicable state and local laws governing nondiscrimination in employment, including recruiting, hiring and placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation and training.

General Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email Address*
Are you legally entitled to work in the U.S.?*
Emergency Contact Information
Name*
First Last
Relationship*
Phone*
Position
Position or Type of Employment Desired:*
Date Available for Work:*
MM slash DD slash YYYY
Are you able to perform the essential functions of the job you are applying for, with or without reasonable accommodation?*
Salary Desired:*
Referred By:*
First Last
Education And Training
High School Graduate or GED Test Passed*
Highest Level Of High School Completed*
High School
Name*
Location*
Year Graduated*
College
Name*
Location*
Studied/Degree*
Did you graduate?*
Trade or Business School
Name*
Location*
Studied/Degree*
Did you graduate?*
Special Skills
Special Skills*
Veteran Information (Most Recent):
Branch Of Service*
Date Of Entry*
MM slash DD slash YYYY
Date Of Discharge*
MM slash DD slash YYYY
Employment Information:
Employer*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title*
Specific Duties*
Employment Dates
From*
MM slash DD slash YYYY
To*
MM slash DD slash YYYY
Hours Per Week*
Last Salary*
Supervisor*
First Last
Reason For Leaving*
May we contact this employer?*
Consent*
I certify that the information contained in the application is true, correct and complete. I understand that, if employed, false statements reported on my application may be considered sufficient cause for dismissal. If I am offered employment I agree to submit to a drug test before starting work. I also agree to submit to a drug test at any time deemed appropriate by Kelsey Construction, LLC (the Company) and as permitted by law. I also understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory drug tests and, if hired, a condition of my employment will be that I abide by the Company’s Drug and Alcohol Policy. In submitting an Online Application I understand that a position may not be open nor does doing so obligate the Company to hire me.
Signature*
Date*
MM slash DD slash YYYY
Pre-Employment Screening Release*
I hereby authorize Kelsey Construction LLC to complete a records request for claim and first report information which is offered to employers through the Open Records Section of the KY Office of Workers' Claims (OWC). I acknowledge by signing below, that I agree to the release of my personal information through the OWC for the purposes of completing a pre-employment screening. The information received by Kelsey Construction LLC will remain strictly confidential and will be used only for the purposes of establishing eligibility for employment.
Signature*
Date*
MM slash DD slash YYYY

Contact Us

Kelsey Construction, LLC
212 Cedar Grove Road
PO Box 904
Shepherdsville, KY 40165

Telephone: 502.955.1410
Fax: 502.921.9092

Job Application

Application For Employment

General Information

Emergency Contact Information

Position

Education And Training

High School

College

Trade or Business School

Special Skills

Veteran Information (Most Recent):

Employment Information:

Employment Dates

Contact Us

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