M.A.DeAtley Construction - Employment Application

Sorry, your browser doesn't support Java(tm).

construction, clarkston, washington

M.A. DeAtley Construction, Clarkston, WA

829 Evans Road, P.O. Box 490, Clarkston, WA 99403
Phone: (509) 751-1580, Fax: (509) 751-1922
E-mail

Download the application here .
Fax the completed application to: 509-751-1922 or mail to: MA Deatley Construction, PO Box 490, Clarkston, WA 99403.

Or fill out the online application below.

Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job related medical condition or handicap.

You must fill out all sections of this application completely and honestly or it will not be accepted. Place "NA" or "none" in fields that do not apply to you. Thank you!

Applicant Data Record

Applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap.

As employers/government contractors, we comply with government regulations and affirmative action responsibilities.

Solely to help us comply with government record keeping, reporting and other legal requirements, please fill out the Applicant Data Record. We appreciate your cooperation.

This data is for periodic government reporting and will be kept in a Confidential File seperate from the Application for Employment.

Date:

Position(s) applied for:

Referral Source:

Advertisement	Friend	Relative	Walk-In
Employment Agency	Other

Name:
(Last, First, Middle Initial)

Address:

City:

State:

Zip:

Phone Number:

Affirmative Action Survey
Government agencies require periodic reports on the age, sex, ethnicity, handicapped and veteran status of applicants. This data is for analysis and affirmative action only. Submission of information is voluntary.

Date of Birth:

Check One:

Male Female

Race Ethnic Group:

White	Black	Hispanic
American Indian / Alaskan Native		Asian / Pacific Islander

Check if any of the following are applicable:

Vietnam Era Veteran

Disabled Veteran

Handicapped Individual

If Veteran status:

Discharge Date:

Federal Job Category:

Reporting State:

Special Employment Notice to Disabled Veterans, Vietnam Era Veterans, and Individuals with Physical
or Mental Handicaps.

Government contractors are subject to 38 USC 2012 of the Vietnam Era Veterans Readjustment Act of 1974 which requires that they take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals.

If you are a disabled veteran, or have a physical or mental handicap, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job to the best of your ability in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect your consideration for employment.

Handicapped Individual	Disabled Veteran	Vietnam Era Veteran

If you wish to be identified, please select the option below I agree I disagree

Have you ever been convicted of a felony within the last 7 years? Yes No
(Conviction will not necessarily disqualify applicant from employment.)

If Yes, please explain:

State Driver's Licence Number:

Expiration Date:

Issuing State:

CDL Endorsements:

Medical Card? Exp.Date:

List all motor vehicle accidents in the last 3 years. Specify date, nature of accident, and any fatalities or injuries it caused.

List all violations of motor vehicle laws other than parking during the last 3 years for which you were not convicted or bond was forfeited.

Has your driver's licence ever been revoked or denied? Yes No

If yes, indicate in detail all facts and circumstances.

Give name, address and phone number of 3 references who are not related to you and are not previous employers.

	Name	Address	Phone
1
2
3
4

Employment Experience
Start with your present or last job.

*List all types of equipment operated including trucks, truck tractors, semi trailers, full trailers, and types of
construction equipment. Indicate the nature of the work performed and the number of years or months operated.

Employer:
Telephone:
Address:
Job Title:
Supervisor:
Reason for leaving:
Work Performed and Equipment Operated:
Were you subject to federal motor carrier safety regulations while employed? Yes No
Were you subject to DOT-required drug and alcohol testing requirements? Yes No
Dates Employed:	From To
Hourly Rate / Salary:	Starting Final

Employer:
Telephone:
Address:
Job Title:
Supervisor:
Reason for leaving:
Work Performed and Equipment Operated:
Were you subject to federal_motor_carrier_safety_regulationswhile employed? Yes No
Were you subject to DOT-required drug_and_alcohol_testing_requirements? Yes No
Dates Employed:	From To
Hourly Rate / Salary:	Starting Final

Employer:
Telephone:
Address:
Job Title:
Supervisor:
Reason for leaving:
Work Performed and Equipment Operated:
Were you subject to federal_motor_carrier_safety_regulationswhile employed? Yes No
Were you subject to DOT-required drug_and_alcohol_testing_requirements? Yes No
Dates Employed:	From To
Hourly Rate / Salary:	Starting Final

Employer:
Telephone:
Address:
Job Title:
Supervisor:
Reason for leaving:
Work Performed and Equipment Operated:
Were you subject to federal_motor_carrier_safety_regulationswhile employed? Yes No
Were you subject to DOT-required drug_and_alcohol_testing_requirements? Yes No
Dates Employed:	From To
Hourly Rate / Salary:	Starting Final

If there is not enough space for the last 10 years of service, please attach a separate sheet.

Explain ALL breaks in employment, state duration and reason:

Education

Elementary

High

College / University

Graduate / Professional

School Name

Years Completed:
(Circle)


4	5	6	7	8


9	10	11	12


1	2	3	4


1	2	3	4

Diploma / Degree

Describe Course of Study

Applicant’s Statement
This certifies that this application was completed by me, and that all entries on it and information in it are true and
complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision and release M.A. DeAtley Construction, Inc., from any and all liability concerning collection and use of information. In accordance with the regulations of the Motor Carrier Safety Administration, the information contained in this application may be used and the applicant’s previous employers will be contacted for the purpose of investigating the applicant’s safety performance history information. I understand that this application is not and is not intended to be a contract of employment.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

Select "I Agree" below if you agree with the above statement.

I agree I do not agree

Application for Employment

Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age,
marital or veteran status, or the presence of a non-job-related medical condition or handicap.

Date of Application:

Position(s) applied for:

Referral Source:

Advertisement	Friend	Relative	Walk-In
Employment Agency	Other

Name:
(Last, First, Middle Initial)

List all addresses at which you resided for 3 years prior to date of application.

	How long at this address?	Address	City	State	Zip
1
2
3

Home Phone:
Cell Phone:
Date of Birth:

Have you filed an application here before?	Yes No If yes, give date:

Have you ever been employed here before?	Yes No If yes, give date:

Are you employed now?	Yes No
May we contact your present employer?	Yes No

Are you prevented from lawfully becoming employed in this country because of VISA or Immigration status?
Yes No
(Proof of citizenship or immigration status may be required upon employment.)

On what date would you be available for work?
Are you available to work:	Full Time Part Time Shift Work Temporary
Are you on a layoff and subject to recall?	Yes No
Can you travel if a job requires it?	Yes No

List any reason to you why you might be unable to perform consistently and promptly the position(s) you have applied for:

AN EQUAL OPPORTUNITY EMPLOYER M/F/V/H