Application for Employment
Your application for employment can be completed by filling out the online form below or by downloading the Application for Employment and printing it for completion by hand and faxing it to (785) 228-2927 or mailing it to: Koss Construction Company, 5830 SW Drury Lane, Topeka, Kansas 66604.
Everything marked with an asterisk (*) is required before submission.
Reason for Leaving
Employer
Name
Address
City, State, Zip Code
Phone Number
Contact Person
Dates Employed
From (Month/Year)
To (Month/Year)
Postion Held
Salary/Wage
Reason for Leaving
Employer
Name
Address
City, State, Zip Code
Phone Number
Contact Person
Dates Employed
From (Month/Year)
To (Month/Year)
Postion Held
Salary/Wage
Reason for Leaving
Employer
Name
Address
City, State, Zip Code
Phone Number
Contact Person
Dates Employed
From (Month/Year)
To (Month/Year)
Postion Held
Salary/Wage
Reason for Leaving
III Skills & Qualifications
Summarize any training, licenses, and characteristics of yourself that may qualify you as being able to perform job-
related functions for the positions which you are applying.*
IV Education
Highschool*
City, State*
College
City, State
College
City, State
Other
City, State
V References
1. Name*
Address*
City, State, Zip Code*
Phone*
2. Name*
Address*
City, State, Zip Code*
Phone*
TO BE READ AND SIGNED BY APPLICANT
This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision.I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.I also understand that prior to being employed, I would be required to submit to a Drug Screen.
Date*
Name*
Koss Construction Company participates in E-Verify to verify employee identity and work authorization.
APPLICANT VOLUNTARY SELF-IDENTIFICATION FORM
Applicants are considered for all positions without regard to race, color, sex, national origin, veteran status, or disability status.As an Affirmative Action/Equal Opportunity Employer, Koss Construction complies with government regulations and affirmative action responsibilities.
Please complete the Applicant Voluntary Self-Identification Form to assist us with government record keeping, reporting, and other legal requirements.The data is for analysis and affirmative action purposes.Submission of information is voluntary and refusal to provide it will not subject you to any adverse treatment.The information will be kept confidential and will only be used in accordance with provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement.When reported, data will not identify any specific individual. Completion of information below is voluntary.Thank you for your cooperation.
Referral Source – Please check one:
Referred by Current EmployeeKoss Internet WebsiteWorkforce CenterNewspaper AdWalk-InJob FairSchoolOther (name of source)
Applicant Affirmative Action Data – Please complete:
Gender
MaleFemale
Race/Ethnicity
Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.White (Not Hispanic or Latino) – CaucasianBlack or African American - A person having origins in any of the black racial groups of Africa.Native Hawaiian or Other Pacific Islander – A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.American Indian/Alaskan Native – A person having origins in any of the original peoples of North and South American (including Central America), and who maintains tribal affiliation or community attachment.Two or More Races – All persons who identify with more than one of the above five races.
Veteran Status
Please check all boxes below that apply. Identification of a veteran status is essential for effective affirmative action data collection and analysis. If you choose to identify your veteran status, the information you provide will be used for statistical purposes only and will not affect your employment in any way.
Are you a veteran?
YesNo
If you are a Veteran, please select one or more of the categories below that apply to you:
Vietnam Era Veteran: A veteran who: (1) Served on active duty in the U.S. military, ground, naval, or air service for a period o more than 180 days, and was discharged or released there from with other than a dishonorable discharge if any part of such active duty occurred: (a) in the Republic of Vietnam between February 28, 1961 and May 7, 1975; or (b) between August 5, 1964 and May 7, 1975 in all other cases; or (2) Was discharged or released from active duty for a service connected-disability if any part of such active duty was performed: (a) in the Republic of Vietnam between February 28, 1961 and May 7, 1975; or (b) between August 5, 1964 and May 7, 1975 in all other cases.Recently Separated Veteran: A veteran who was discharged or released from active duty in the U.S. Military within the last three (3) years.Special Disabled Veteran: A veteran of the U.S. military, ground, naval or aid service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans’ Affairs for disability – a) rated at 30% or more; b) rated at 10 or 20% in the case of a veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap; or c) a person who was discharged or released from active duty because of service connected disability.Other Protected Veteran: A veteran who served on active duty in the U.S. military ground, naval, or air service during was or in a campaign or expedition for which a campaign badge has been authorized under laws administered by the U.S. Department of Defense. The information required to make this determination is available at: http://www.opm.gov/veterans/html/vgmedal2.asp or by calling (310) 306-6752.
Disability Status
Please check the box below if applicable. Self-identification of disability status I essential for effective affirmative action data collection and analysis. If you choose to self-identify your disability status, the information you provide will be used for statistical purposes only and will not affect your employment in any way.
Are you an individual with disabilities? (Definition of Disability: A person has a disability if he or she has a physical or mental impairment which substantially limits one or more major life activities; has a record of such impairment, or is regarded as having such impairment. A handicap is “substantially limiting” if it is likely to cause difficulty in securing, retaining or advancing in employment.)
Yes, I am disabledNo, I am not disabled
**Please submit form once. If it appears that the form didn't submit correctly, please go through your application and make sure that everything marked with an asterisk (*) is completed. Check your email inbox for verification that your application was submitted successfully.