CAREERS

Last Name

First Name

M.I

Date

Present Address

Apartment/Unit #

City

State

ZIP

Phone

E-mail Address

Date Available

Are you 18 years of age or older

Position Applied for

Are you a citizen of the United States?

YESNO

If no, are you authorized to work in the U.S?

YESNO

Have you ever worked for this company?

YESNO

If so, when?

Do you have a valid driver license?

YESNO

If yes, DL#

Do you have a CDL license?

YESNO

Please list three professional references

Full Name

Relationship

Phone

Full Name

Relationship

Phone

Full Name

Relationship

Phone

Company Name

Phone

Address

Supervisor

Job Title

Staring Salary

Ending Salary

Responsibilities

From

To

Reason for leaving

Company Name

Phone

Address

Supervisor

Job Title

Staring Salary

Ending Salary

Responsibilities

From

To

Reason for leaving

Company Name

Phone

Address

Supervisor

Job Title

Staring Salary

Ending Salary

Responsibilities

From

To

Reason for leaving

Have you had any traffic violations in the past 5 years?

YESNO

If yes, explain?

Have you been convicted of a crime in the past five years?

YESNO

If yes, explain?

Can you perform essential functions of the job with or without reasonable accommodation?

YESNO

If yes, explain?

Have you ever operated a dump truck?

YESNO

If yes, explain?

Have you ever operated a skid-loader?

YESNO

If yes, explain?

Willing and able to travel for occasional out-of-state work when needed?

YESNO

Are you able to work overtime?

YESNO

When are you available to start work?

CDL Truck Class ACDL Truck Class BSkid SteerBackhoeBulldozerGrade TractorExcavatorPaverPraving Operations(i.e. lute, shovel, tamp)
Other

Name

Signature

DATE