List names of employers in consecutive order with your present or most recent first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. NOTE: A job offer may be contingent upon acceptable references from current and former employers.

Please read each statement carefully before signing.

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers, and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I understand I will be required to successfully pass a Drug Screening Examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment. I understand SEMA may also perform a Background Check which could include checking references, past employment, education/training history, criminal history, and/or credit history. Post-hire, SEMA may additionally obtain a Workers Compensation History to assure the employee is assigned duties with in restrictions.

I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete Pre-Employment Physical Examination (Fit for Duty). I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.

I understand that this application, verbal statements by management, or subsequent employment does not create an express or implied contract of employment nor guarantee employment for any definite period of time. Only the Corporate President/CEO of SEMA has the authority to enter into an agreement of employment for any specified period and such agreement must be in writing, signed by the Corporate President/CEO and the employee. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without reason and with or without notice.

I understand that I may be terminated if I have falsified any information on this application. I have read, understand, and by my signature consent to these statements.

Affirmative Action Survey

It is the policy of SEMA Construction, Inc. (SEMA) to provide equal employment opportunities to all qualified applicants for employment without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, veteran status or disability. As an affirmative action employer under E.O. 11246, we invite all applicants to identify themselves as indicated below. The information collected is used for compliance with government regulations and record keeping guidelines.

COMPLETION OF THIS FORM IS VOLUNTARY AND IN NO WAY AFFECTS THE DECISION REGARDING YOUR APPLICATION FOR EMPLOYMENT. THIS FORM IS CONFIDENTIAL AND WILL BE MAINTAINED SEPARATELY FROM YOUR APPLICATION FORM.