Employment Application

Position(s) Applied For: Are you looking for: Full time Part-time Temporary Date available to work:
Are you on layoff or subject to recall: Yes No Do you have a current DOT health card? Yes No Have you applied before? Yes No Give date: Have you been employed here before? Yes No if yes, last day How did you learn about us? Friend Advertisement Relative Walk-in Employment Agency Other Do you know someone that is working for us now? Yes No Who? Person & phone # to contact in case of emergency:

Street Address City State Zip Telephone Social Security #:

Drivers' License Information Drivers' License #: State Expiration Date Class Number of points on your license Do you have a license in another state? Yes No Other state:  Do you have a COMMERCIAL DRIVER’S LICENSE? Yes No CDL license number

Start with your present or most recent job. Account for all time periods including military service, unemployment, and volunteer activities. Exclude organizational names which indicate race, color, religion, creed, sex or national origin.

Single Axle Dump Trucks Tandem Axle Dump Trucks Tanker Trucks Flat Bed Trucks Ready Mix Trucks Motor Graders Wheel Scrapers Backhoe Loaders Wheel Loaders Track Type Loaders Track Type Tractors TractorTrailers Vibratory Compactors Vibratory Rollers Hydraulic Excavators Air Compressors Lasers Welders

Calculator Typewriter PC Fax Other

Employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status.As an employer with an Affirmative Action Program, we comply with government regulations, including Affirmative Action responsibilities where they apply.The purpose for this Data Record is to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of this section is required by Equal Employment Opportunity Company (EEOC) guidelines. This data will be kept in a confidential file and is not considered as part of your application for employment.

This portion of the application is not required, voluntary only.

Gender: Male Female

Ethnicity: White Black Hispanic American Indian/Alaskan Asian/Pacific Islander Other

Check If Any Of The Following Are Applicable: Vietnam Veteran Disabled Veteran Handicapped

Birthdate: