<p> EMPLOYMENT APPLICATION F.S. Lopke Contracting, Inc. 3430 State Rte. 434, Apalachin, NY 13732 Phone: 607-687-1114 Fax: 607-687-1856</p><p>Name: ______Phone: ______</p><p>Address: ______</p><p>City: ______State: ______Zip: ______</p><p>Social Security #: ______Drivers License #: ______</p><p>Position Desired: ______</p><p>Rate of Pay: ______High School: ______Trade School: ______Employment History College: ______Last Job First Special Skills: ______</p><p>Employer: ______Begin: ______End: ______Address: ______Person directly worked for: ______Phone: ______Position held/duties: ______Rate of Pay: ______</p><p>Employer: ______Begin: ______End: ______Address: ______Person directly worked for: ______Phone: ______Position held/duties: ______Rate of Pay: ______</p><p>Employer: ______Begin: ______End: ______Address: ______Person directly worked for: ______Phone: ______Position held/duties: ______Rate of Pay: ______</p><p>Personal References: Name:______Address: ______Phone: ______Name:______Address: ______Phone: ______Name:______Address: ______Phone: ______</p><p>When Could You Start Work: ______</p><p>Application Date: ______Signature: ______</p><p>Application must be filled out completely to be deemed complete. All potential employees must pass a pre-employment drug test before beginning work.</p><p>“A Drug Free Workplace” </p>