Your regional highway, earthen construction, and excavation company with a rich history in the Northwest.

Job Application: Lead Haul Truck Driver – WA

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

Title: Lead Haul Truck Driver – WA

Fields marked with an asterisk (*) must be filled out before submitting.

Date
Position(s) seeking
Referral Source Advertisement
Employment Agency
Friend
Relative
Walk-In
Other
If Other, explain
 
Full Name *
List all addresses at which you resided for 3 years prior to date of application.
Address *
City *
State *
Zip *
Time at Address
 
Address
City
State
Zip
Time at Address
 
Address
City
State
Zip
Time at Address
 
Home Phone with area code *
Cell Phone with area code
Email *
Applied here before? Yes
No
If Yes, then date
Employed here before? Yes
No
If Yes, then date
Employed now? Yes
No
May we contact employer? Yes
No
Prevented from Employment due to VISA or Immigration? Yes
No
Proof of citizenship or immigration status may be required upon employment.
Date you can start?
Available for Full Time
Part Time
Shift Work
Temporary
On lay-off, subject to recall? Yes
No
Can you travel if needed? Yes
No
Any difficulties performing job?
Hold current Drivers License? Yes
No
Do you have a CDL? Yes
No
State Drivers License #
Drivers License expiration
Issuing State
CDL Endorsements
Medical Card #
Card expiration date
Vehicle accidents last 3 years
Other violations last 3 years
Drivers license ever revoked or denied? Yes
No
If Yes, indicate facts, circumstances and dates
Give name, address and phone number of 3 references who are not related to you and are not previous employers.
Reference 1
Reference 2
Reference 3

Employment Experience

Start with present or last job. Must include all work experience for the last 10 years. List all types of equipment operated including trucks, truck tractors, semi trailers, full trailers, and types of construction equipment. Indicate nature of the work performed and the number of years or months operated.

Employer 1

Employer
Telephone
Address
Job Title
Supervisor
Reason for Leaving
Work performed Equipment operated
Subject to Federal Safety Regulations? Yes
No
Subject to DOT-required drug/alcohol testing? Yes
No
Employed From and To
Hourly Rate Starting and Final

Employer 2

Employer
Address
Job Title
Supervisor
Reason for Leaving
Work performed Equipment operated
Subject to Federal Safety Regulations? Yes
No
Subject to DOT-required drug/alcohol testing? Yes
No
Employed From and To
Hourly Rate Starting and Final

Employer 3

Employer
Address
Job Title
Supervisor
Reason for Leaving
Work performed Equipment operated
Subject to Federal Safety Regulations? Yes
No
Subject to DOT-required drug/alcohol testing? Yes
No
Employed From and To
Hourly Rate Starting and Final

Employer 4

Employer
Address
Job Title
Supervisor
Reason for Leaving
Work performed Equipment operated
Subject to Federal Safety Regulations? Yes
No
Subject to DOT-required drug/alcohol testing? Yes
No
Employed From and To
Hourly Rate Starting and Final
If there is not enough space for the last 10 years of service, please email a separate sheet to web@madcon.net
Explain ALL breaks in employment with duration and reason

Elementary

School Name
Years completed 4
5
6
7
8

High School

School Name
Years completed 9
10
11
12
Diploma/Degree
Describe Course of Study

College/University

School Name
Years completed 1
2
3
4
Diploma/Degree
Describe Course of Study

Graduate/Professional

School Name
Years completed 1
2
3
4
Diploma/Degree
Describe Course of Study

Applicants 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.
Agree or Disagree to Applicants Statement I agree
I disagree

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.
DOB
Gender Male
Female
 
Race/Ethnic Group White
Black
Hispanic
American Indian/Alaskan Native
Asian/Pacific Islander
Dont care to answer
 
Any applicable? Vietnam Era Veteran
Disabled Veteran
Handicapped Individual
None of the above

If Veteran status

Dicharge Date
Federal Job Category
Reporting State
 
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