KOTA Construction 
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NAME:
STREET ADDRESS:
CITY:
STATE:

ZIPCODE:
PHONE NUMBER:
E-MAIL:
DATE:
*Are you a citizen of the United States?
EMPLOYMENT APPLICATON
D.O.B.
*If no are you authorized to work in the U.S.?
*Have you ever been convicted of a felony?
*Have you ever worked for KOTA before?
*Do you have a valid drivers license?
*Do you have a valid CDL License?
*Do you have your own transportation?
*Are you able to work out of town if needed?
*Do you have any health issues that would prevent you from performing your work?
If yes, Explain
EXPERIENCE
(OPERATOR EXPERIENCE)
(LABOR EXPERIENCE)
POSITION APPLYING FOR:
DESIRED SALARY:
COMMENTS
*Are you currently employed?
*Are you able to work occasional Saturdays?
(This is a Preliminary Application, If Selected you will be asked come in for an interview) 
How did you hear about KOTA Construction?
YESNO
YESNO
YESNO
YESNO
YESNO
YESNO
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Dozer
Motor Grader
Mini Ex
Backhoe
Trackhoe
Roller
Truck Driver
Lowboy Driver
Water Main
Sewer Main
Concrete
Conduit
Storm Drain
Shooting Grade
Pipe Laser
Reading Prints
YESNO
YESNO