Application for Employment
Applicant: READ AND SIGN BEFORE SUBMITTING THIS APPLICATION.
I understand that the information will be used and that the prior employers will be contacted for purposes of investigation as required by 391.23 of the Motor Carrier Safety Regulations.
Position Applying For
PERSONAL INFORMATION
First Name
Last Name
Address
Phone Number
Email Address
Date of Birth
Are you a citizen of the United States?Yes
No
If no, do you posses a valid work permit?Yes
No
Are you currently employed?Yes
No
If yes, reason for leaving employment?
If no, how long since last having employment?
Rate of pay expected?
Labor union affiliation (show name of union and local)
Have you ever been covicted of a crime or felony?Yes
No
If yes, explain
Date of last DOT physical examination?
EXPERIENCE AND QUALIFICATIONS - OPERATING
ExperienceDozer
Skidsteer
Backhoe
Loader
Dump Truck
Years of experience
ExperienceDozer
Skidsteer
Backhoe
Loader
Dump Truck
Years of experience
ExperienceDozer
Skidsteer
Backhoe
Loader
Dump Truck
Years of experience
ExperienceDozer
Skidsteer
Backhoe
Loader
Dump Truck
Years of experience
ExperienceDozer
Skidsteer
Backhoe
Loader
Dump Truck
Years of experience
EMPLOYMENT RECORD
Note: DOT requires that employment for at least 5 years be shown. You may email additional employment history to employment @jdexcavating.com or fax to 763-862-1223
Last Employer
Address
Position Held
Job Duties
From
To
Salary
Reason for leaving
Last Employer
Address
Position Held
Job Duties
From
To
Salary
Reason for leaving
Last Employer
Address
Position Held
Job Duties
From
To
Salary
Reason for leaving
EXPERIENCE AND QUALIFICATIONS - DRIVING
Drivers License
Type
License Number
State
Experation Date
Have you ever been denied a license, permit or privilege to operate a motor vehicle?Yes
No
Has a license, permit or privilege ever been suspended or revoked?Yes
No
If the answer to either of the above questions is yes, please explain
ACCIDENT RECORD FOR THE PAST 3 YEARS
If additional space is needed, email at employment@jdexcavating.com or fax to 763-862-1223
Date of accident
Nature of accident (head-on, rear-end, etc.)
Fatalities or injuries to either party?Yes
No
If yes, please explain
TRAFFIC FIOLATIONS AND FORFEITURES FOR THE PAST 3 YEARS
Do not include parking violations. If additional space is needed, you can email at employment@jdexcavating.com or fax to 763-862-1223
Date of violation
Location
Charge
Penalty
Date of violation
Location
Charge
Penalty
TO BE READ BY APPLICANT
It is agreed and understood that any misrepresentations of information given above shall be considered an act of dishonesty and sufficient cause for dismissal. It is agreed and understood that the employer or his/her agents may investigate the applicant's background to obtain any and all information of concern to applicant's record, and applicant releases employers and persons named herein from all iability for any damages on account of his/her furnishing such information. The applicant agrees to furnish such additional information and complete such examinations as may be required to complete his employment file. It is agreed and understood that this application for employment in no way obligates to employ applicant. It is agreed and understood that if hired, the employee may be on a probationary period of up to 60 days, in which time he may be discharged without recourse.
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.
Electronic Signature (Signature must be in the form of all caps to be valid)
Date
