Concord, Virginia
(434) 993-2214

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Burleigh Construction

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Employment
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Application For Employment

At Burleigh Construction, we believe that hard work and dedication should be rewarded, which is why this company is owned by an Employee Stock Ownership Plan. Employees that stay with the company are awarded with stock in the company, enabling them to directly benefit from their labor and take pride and interest on the future of our company.

To apply for employment at Burleigh Construction, please fill out the form below or print this application and mail it to:

Burleigh Construction Co., Inc.

Post Office Box 289

Concord, Virginia 24538

Burleigh Construction is an Equal Opportunity Employer.

Employment Application

Basic Information

Tell us about yourself

Date of Application *

Prefix

First Name *

Middle Name

Last Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Home Telephone Number *

Cellular Number *

Email Address *

Resume and/or Cover Letter *

Drag and Drop (or) Choose Files

Do you have a valid driver's license? *YesNo

Do you have a reliable means of transportation to and from work if hired? *YesNo

Are you at least 18 years of age? *YesNo

If hired, can you present evidence of U.S. citizenship or your legal right to live and work in this country? *YesNo

Have you ever been convicted of a crime other than minor traffic violations? *YesNo

Please explain the nature of the crime and the results of the court case: *0 / 150

Skills and Experience

Position applying for: *0 / 30

Date you would be available to start work: *

How did you hear about us? *0 / 30

Are you employed now? *YesNo

May we contact your current employer? *YesNoN/A

Our type of work requires some weekend work. Would you be available to work on weekends? *YesNo

Are you able to perform tasks associated with construction, such as bending, lifting, and carrying heavy loads? *YesNo

Please explain: *0 / 50

Occasionally, work crews are required to stay out of town overnight. Would you be able to stay out of town during the week if required? *YesNo

Have you ever applied with us before? *YesNo

If so, when? *

Highest education grade completed: *Lower89101112Grad

College/Trade School0 / 10

Do you have particular skills, certifications, or qualifications which you would like to share in relation to this type of work?0 / 150

Can you operate any type of equipment?0 / 150

Employment History

Please list three most recent

Name of Employer *

Street Address *

City *

State/Province *

ZIP / Postal Code *

Phone *

From *

To *

Position *0 / 30

Wage (annual) *

USD

Reason for Leaving *0 / 250

Name of Employer

Street Address *

City *

State/Province *

ZIP / Postal Code *

Phone *

From *

To *

Position *0 / 30

Wage (annual) *

USD

Reason for Leaving *0 / 250

Name of Employer

Street Address *

City *

State/Province *

ZIP / Postal Code *

Phone *

From *

To *

Position *0 / 30

Wage (annual) *

USD

Reason for Leaving *0 / 250

Name

Street Address *

City

State/Province

ZIP / Postal Code

Phone *

Years acquainted *

Name

Street Address *

City

State/Province

ZIP / Postal Code

Phone *

Years acquainted *

Please read the following statements and sign by typing your full name below: By typing my full name below, I certify that the answers given in this application for employment are true and correct to the best of my knowledge. I authorize any inquiry into the statements made in this application as may be necessary in reaching an employment decision. I understand that any false or misleading information given in this application or during a pre-employment interview, including failure to disclose requested information, may result in my discharge. I understand that I will be required to pass a drug test before a final offer of employment is made. By typing my full name below, I consent to these procedures. I understand that if I voluntarily terminate my employment within the first 30 calendar days, the cost of this procedure will be deducted from my final paycheck. I also understand that I will be required to provide, at my own expense, a copy of my DMV driving record and that an unsatisfactory driving record could be grounds for not being offered employment. I understand that any employment relationship with this employer is "at-will", which means that the employee may resign at any time and the employer may discharge the employee at any time, with or without cause. I also understand that this at-will employment relationship may not be changed by any written document or by any behavior, unless the change is specifically acknowledged in writing by M. Phillip Burleigh.

Signature of applicant *0 / 60

Date *

DUE TO REPORTS REQUIRED BY AFFIRMATIVE ACTION AND EQUAL OPPORTUNITY, THE FOLLOWING NEEDS TO BE ANSWERED.

Sex *0 / 15

Race *0 / 15

Find Us

Address

7610 Village Hwy, Concord, VA 24538

Hours

Monday--Thursday: 7:00AM-5:00PM

Friday: 7:00AM-4:00PM