Application Date MM/DD/YYYY: *
Date Available MM/DD/YYYY: *
Name *
Last Name: *
Phone: *
E-Mail *
Date Of Birth MM/DD/YYYY:
Current Address: *
City: *
State: *
Zip Code: *
Desired Hours Per Week: 20-40 (PartTime) 40+ (Full Time)
Position(s) Applying For: * Crew Member (Asphalt) Crew Member (Maintenance) CDL Truck Driver Crew Lead (Asphalt) Estimator/Sales Assistant
Rate of pay expected?
How did you hear about us?
If referred by someone, who referred you?
List Addresses For The Past Three Years 1: *
Past Address Dates MM/DD/YYYY: *
List Addresses For The Past Three Years 2: *
Dates MM/DD/YYYY: *
List Addresses For The Past Three Years 3: *
Dates MM/DD/YYYY: *
Education: * High school College University
Location: *
Years Attended MM/DD/YYYY:
Graduate? * No Yes
Degree Received:
Can you perform the essential function of the job you are applying for, with or without reasonable accommodations? * Yes No
If hired, do you have reliable means of transportation to work? * Yes No
Have you ever been convicted of a felony or released from prison within the past 10 years for an offense? * Yes No
Do you have a mobile device (cell phone) that you can use for daily communication? * Yes No
Are you currently employed? * No Yes
If NO, when was your last date of employment?
Describe any previous industry experience and/or training, qualifications or skills which make you especially suited for work here. *
Most Recent Employer:
Employer Address:
City:
State:
Zip Code: *
From:
To:
Position Held:
Wage:
Reason for Leaving:
Duties:
Recent Employer Contact:
Phone: *
Gaps In Employment: Please explain any gaps in employment during the past three years.
Dates From:
Dates To:
Reason:
Accident Record For Past 3 Years From Date Of Application I had an accident in the last three years: Yes No
If yes, describe Date:
Nature of accident, # of injuries? # of fatalities?
If yes, describe Date:
Nature of accident, # of injuries? # of fatalities?
Do you have any Traffic Convictions & Forfeitures In The Past 3 Years? No Yes
Location:
Charge:
Date:
Penalty:
Please explain any of these convictions above:
Experience and Qualifications: Please list any other licenses or qualifications here:
Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Yes No
Has any license, permit, or privileged ever been suspended or revoked? Yes No
Driver Experience: Class of Equipment Operated Truck Tractor Semi-Trailer Other
Type of Equipment Operated Van Tank Flat Trailer
Experience Dates From:
Experience Dates To:
Approx. Mileage:
Do you have a valid Commercial Drivers License (CDL)? No Yes Class A Yes Class B
CDL APPLICANTS: ARE YOU AT LEAST 21 YEARS OF AGE? No Yes
List any trucking, transportation, construction, equipment or other experience and training that may help in your work for this company:
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. I hereby authorize Alpha Paving Seal Coating, LLC to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize my former employers to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release Alpha Paving Seal Coating, LLC, my former employers and all other persons, or legal entities from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. Alpha Paving Seal Coating, LLC is an at-will employer. * I have read and acknowledge the above statement (Required) *
I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be "at will" and without fixed term, and may be terminated at any time, with or without notice, at the option of either the employer or the employee. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the company unless made in writing. If I am offered employment I agree to submit to a medical examination and a drug test before starting work. If employed, I also agree to submit to a medical examination and drug test at any time deemed necessary by the employer, and as permitted by law. I consent to having such examinations and tests, and I request that the examining doctor disclose to the company the results of my examination, which shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug tests, and if I am hired a condition of my employment will be that I abide by the company’s drug and alcohol policies. I understand that filling out this form does not indicate there is a position open and does not obligate the company to hire. If hired, I agree to abide by all company work rules, policies, and procedures. The company retains the right to revise its policies or procedures, in whole or in part, at any time. * I have read and acknowledge the above statement (Required) *
