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Ready-Mix Concrete
Sand & Gravel Hauling
Locations
(706) 595-2273
Concrete Calculator
Home
About Us
Our Team
Our History
Terms & Conditions of Sale
Applications
Employment Application
Credit Application
Products
Ready-Mix Concrete
Sand & Gravel Hauling
Locations
(706) 595-2273
Concrete Calculator
Employment Application
DRIVER EMPLOYMENT APPLICATION
Applicant Information
Name
*
First Name
Last Name
Phone
*
(###)
###
####
Email
*
Date of Birth
*
MM
DD
YYYY
Social Security #
*
Position Applied For
*
Date Available For Work
*
MM
DD
YYYY
Do you have legal right to work in the United States?
*
Yes
No
Current Residency
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
License Information
No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below.
License
*
State, License #, Type/Class, Expiration Date
Driving Experience
*
Include Class/Type of Equipment, & Length of Time Operating
Accident Record for the Past 3 Years
Include Dates (List most recent first), Nature of Accident, # Fatalities, # Injuries, Chemical Spills (Y/N)
Traffic Convictions & Forfeitures for the Past 3 Years
Include Date Convicted (Month/Year), Violation, State of Violation, & Penalty
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
*
Yes
No
Has any license, permit, or privilege ever been suspended or revoked?
*
Yes
No
Employment History
The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for a total of ten (10) years).
Current (Most Recent) Employer
*
Include Name, Phone Number, & Address
Position Held
*
Include from Month/Year - to Month/Year, & Salary of Position
While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
*
Yes
No
Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
*
Yes
No
Second (Most Recent) Employer
*
Include Name, Phone Number, & Address
Position Held
*
Include from Month/Year - to Month/Year, & Salary of Position
While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
*
Yes
No
Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
*
Yes
No
Third (Most Recent) Employer
Include Name, Phone Number, & Address
Position Held
Include from Month/Year - to Month/Year, & Salary of Position
While employed here, were you subject to the Federal Motor Carrier Safety Regulations?
Yes
No
Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40?
Yes
No
Education History
Current (Most Recent) Education
*
Include School (Name & Location), Course of Study, Years Completed, & Additional Details
Other Qualifications
*
Please list any other qualifications that you have and which you believe should be considered.
To Be Read & Signed By Applicant
I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, 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. 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 I am required to abide by all rules and regulations of the Company. I understand that the information I provide regarding my current and/or prior employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23. I understand that I have the right to: • Review information provided by current/previous employers; • Have errors in the information corrected by previous employers, and for those previous employers to resend the corrected information to the prospective employer; and • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information. This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.
Applicant Signature
*
Agreement to Use Electronic Signature
*
I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By selecting “I agree” using any device, means, or action, I consent to the legally binding terms and conditions of this document.
Date
*
MM
DD
YYYY
Thank you!
