Employee Information Sheet - NEW HIRE

    Employee Name
    Date of Birth
    Social Security #
    Present Address
    Phone Number
    Cell Number
    Race
    Union Affiliation:
    Years of Membership:
    Maritial Status:SingleMarriedSeperatedDivorcedWidowed   
    Sex: MF
    In case of emergency-who can we contact? Please use another number than your home number
    Name
    Phone
    Address
    Relationship to you
    Your email address
    Please list your last 3 employers:

    Employer/Address to from work performed
    1
    2
    Please provide a copy of your Drivers License and Social Security Card and OSHA 10 Card

    Economy Paving Co.,Inc. is an Equal Opportunity Employer

    Have you received COMPENSATION OR DISABILITY BENEFITS?
    YESNo
    If YES- Please describe the nature and extent of your previous injury:
    Do you have any present disabilities or limitations?
    YesNo
    if yes, please describe
    List any other serious injuries or illness which may affect your ability to perform your job duties:
    Do you have a valid drivers license:
    YesNo
    Economy Paving reserves the right to request a Drivers License Abstract at our discretion with regards to each employee's license.
    Class of license:
    State of license:
    license Number:
    Date of Expiration:
    A separate employee eligibility verification form I-9 should be submitted with this form

    I have received and read a copy of the standard employment packet. If I have any questions regarding information included in the packet I will contact Economy Paving Co. Inc. I have received and read a copy of the standard employment packet. If I have any questions regarding information included in the packet I will contact Economy Paving Co. Inc.

    I realize the failure to comply with them could result in termination of employment. I realize the failure to comply with them could result in termination of employment.

    Economy Paving Company, Inc. is an Equal Opportunity Employer
    Providing The Information Below Is Optional
    Name:
    Sex:
    Race:



    By adding the date and my name to the signature line below, I certify that the answers given herein are true and complete to the best of my knowledge. I realize that any miss representation in the information submitted or any intention of withholding of essential information called for in this form may result in my immediate dismissal.

    Date:
    Electronic Signature: