Employment Application

An Equal Opportunity Employer

You will be considered for all positions without regard to race, color, religion, weight, height, sex, national origin, marital status, veteran status, the presence of a non-job-related medical condition, handicap, or any other protected status required by law.

Personal Information

First Name

Middle Name

Last Name

Street Address

City

State

Zip

How long at this address

Phone

Position you are applying for

Desired Salary

Can you travel if required?

Yes No

Are you under 18 years of age?

Yes No

If under 18, can you provide a work permit?

Yes No

Applying for

Full-time Part-time Temporary

Are you currently employed?

Yes No

If employed, why do you wish to change?

Have you applied for employment here before?

Yes No

Have you ever been employed by our company?

Yes No

Do you have experience in the building materials industry?

Yes No

On what date would you be available to start work?

May we contact your present and previous employers?

Yes No

Have you been convicted of a felony in the last 7 years?

Yes No

To comply with laws concerning the employment of illegal aliens, can you provide proof of employability?

Yes No

Proof of citizenship or immigration status will be required upon employment.

Education

High School

Name & Location

Did you Graduate?

Yes No

Letter grade or GPA

College

Name & Location

Major field of study

Did you graduate?

Yes No

Letter grade or GPA

Other

Name & Location

Major field of study

Did you graduate?

Yes No

Letter grade or GPA

List any professional, trade, business, or civic activities and offices held. You may exclude membership which would reveal sex, race, religion, national origin, age, ancestry, or handicap, or any other protected status.

Military Status

Branch of Service

Rank Held

Nature of Duties

Entry

Release

What specialized training did you receive?

Do you have a reserve or National Guard obligation?

Yes No

If you have a National Guard obligation, please describe.

Employment History

If records are under a different name, please provide name for reference purposes, starting with present of last employer. List all employment including part-time or temporary positions.

Employer 1

Employer Name

Phone

Date Employed From

Date Employed To

City

State

Zip

Beginning Salary

Ending Salary

Name of Supervisor

Reason for leaving

Title & duties at beginning of employment

Title & duties at end

Employer 2

Employer Name

Phone

Date Employed From

Date Employed To

City

State

Zip

Beginning Salary

Ending Salary

Name of Supervisor

Reason for leaving

Title & duties at beginning of employment

Title & duties at end

Employer 3

Employer Name

Phone

Date Employed From

Date Employed To

City

State

Zip

Beginning Salary

Ending Salary

Name of Supervisor

Reason for leaving

Title & duties at beginning of employment

Title & duties at end

Employer 4

Employer Name

Phone

Date Employed From

Date Employed To

City

State

Zip

Beginning Salary

Ending Salary

Name of Supervisor

Reason for leaving

Title & duties at beginning of employment

Title & duties at end

References

Give the name, address and phone number of three references not related to you.

Reference 1

Name & Relationship

Address

Telephone Number

Reference 2

Name & Relationship

Address

Telephone Number

Reference 3

Name & Relationship

Address

Telephone Number

Driver Information

Experience and Qualifications

Drivers Licenses

State

License Number

Type

Expiration Date

Drivers Licenses

State

License Number

Type

Expiration Date

Drivers Licenses

State

License Number

Type

Expiration Date

Driving Experience

Type of Equipment

Date From

Date To

Approximate # of Miles Driven (total)

Driving Experience

Type of Equipment

Date From

Date To

Approximate # of Miles Driven (total)

Driving Experience

Type of Equipment

Date From

Date To

Approximate # of Miles Driven (total)

Accident Record

Accident 1

Date

Type of Accident

Fatalities

Yes No

Injuries

Yes No

Accident 2

Date

Type of Accident

Fatalities

Yes No

Injuries

Yes No

Accident 3

Date

Type of Accident

Fatalities

Yes No

Injuries

Yes No

Traffic Convictions

List all convictions and forfeitures for the past 3 years (other than parking violations).

Conviction 1

City

State

Date

Charge

Penalty

Conviction 2

City

State

Date

Charge

Penalty

Conviction 3

City

State

Date

Charge

Penalty

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

Yes No

If the answer is yes, list details

Has your license, permit, or privilege to drive ever been suspended or revoked?

Yes No

If the answer is yes, list details

I understand that by law, the company requires all persons applying for positions as truck drivers of vehicles 26,001 pounds or more, to undergo a pre-employment drug test. I understand that refusal to undergo this test will be considered as a withdrawal of my application. I also understand that if the test discloses the presence of an illegal foreign substance, I will be denied employment.

Please type your initials

This application for employment is to be read and signed by applicant. This certifies that this application was completed by the applicant, and that all entries and information on it are true and complete to the best of the applicant’s knowledge.

Type your name