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Lakeshore Poured Walls Inc.
GENERAL LABORER
EMPLOYMENT APPLICATION
616-848-0003 | lakeshorepouredwalls.com
PAGE 1 OF 3
POSITION: Concrete / Poured Wall General Laborer – Willing to Train
Complete all applicable sections. Please print clearly if completing by hand.
Applicant Information
Full Legal Name
Preferred Name
Date
Street Address
City / State / ZIP
Phone
Email
How did you hear about us?
Referred by (if applicable)
Availability & Work Requirements
Earliest Start Date
Desired Hourly Rate
Days / Hours Available
Are you legally authorized to work in the United States?
Will you now or in the future require employment sponsorship?
Do you have reliable transportation to report to assigned job sites?
Can you work outdoors in changing weather and jobsite conditions?
Are you available for early starts and occasional overtime as needed?
Can you perform the essential functions of this job, with or without reasonable accommodation?

Note: The company may discuss job duties and reasonable accommodation after an applicant identifies a need. Do not provide medical information on this application.

Driver / Jobsite Information
If the job requires driving a company vehicle, do you currently hold a valid driver license?
License State (if applicable)
Restrictions / Notes (optional)
Lakeshore Poured Walls Inc.
GENERAL LABORER
EMPLOYMENT APPLICATION
616-848-0003 | lakeshorepouredwalls.com
PAGE 2 OF 3
Construction & Concrete Experience
Check any areas in which you have hands-on experience:
Describe your most relevant construction, concrete, or labor experience
Safety Training / Certifications
Certification details, expiration dates, or other training
Employment History
EMPLOYER 1
Company
Job Title
Dates Employed
Supervisor
Phone
Reason for Leaving
EMPLOYER 2
Company
Job Title
Dates Employed
Supervisor
Phone
Reason for Leaving
Lakeshore Poured Walls Inc.
GENERAL LABORER
EMPLOYMENT APPLICATION
616-848-0003 | lakeshorepouredwalls.com
PAGE 3 OF 3
Education / Training
School / Program / Trade Training
Degree, Diploma, GED, Certificate, or Coursework
Professional References
Reference 1 – Name
Relationship
Phone / Email
Reference 2 – Name
Relationship
Phone / Email
Additional Information
Anything else you would like us to know about your experience, availability, or qualifications?
Resume Upload (Optional)
Applicant Statement & Authorization

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that false or misleading information may result in disqualification from consideration or, if hired, corrective action up to and including termination. I authorize Lakeshore Poured Walls Inc. to verify information relevant to my qualifications and employment history as permitted by law. I understand that this application is not a contract or guarantee of employment.

Applicant Signature (typed or handwritten)
Date
Lakeshore Poured Walls Inc. | Serving West MichiganEqual Opportunity Employer