Please provide the following contact information:

Can you pass a drug test? Yes No

Position(s) Applying for:

(Examples: Operator, Driver, Laborer, Finisher, Pipe Layer, Asphalt)

General Information

Enter your Date of Birth: -- mm/dd/yyyy

Do You have a valid Driver's License? Yes No

Have you ever had your license revoked? Yes No

Truck Driving Position 

If you are applying for a truck driving position, please answer the following:

What class of license and endorsements do you hold?

Can you provide a current physical? Yes No

Indicate which of the following trucks you have driven:

Straight truck? Yes No Approximate miles?
Tractor trailer? Yes No Approximate miles?

Other? N/A if None Approximate miles?

Description of Other
N/A if None

Have you had any traffic convictions and/or forfeitures in the past three years?

Yes No

Have you had any vehicle accidents in the last five years? Yes No
Were there injuries? Yes No
Were there fatalities? Yes No

Pipe Experience

List which areas of work you have performed such as Storm sewer; Water lines; Services; and Laser:
N/A if not Applicable 

Other pipe experience:
N/A if not Applicable    

Years of Experience:

Please give details of your pipe work experience & history: N/A if not Applicable

Operators 

Select what equipment you have operated such as Track hoe; Back hoe (rubber tires); Front end Loaders; and Blade:
N/A if not Applicable

Other equipment operated:
N/A if not Applicable
 
Years of Experience:

Please give brief detail of your equipment operating experience: N/A if not Applicable 

Asphalt Experience

Have you ever worked on an Asphalt Crew? Yes No

Years of Experience:

If yes, list the positions and time you held each one:
N/A if not Applicable

Give a brief explanation of experience for Highway Paving; City/Municipal Streets; Parking Lot & Other Like; Patching:
N/A if not Applicable

Asphalt Operator

(Examples: Paver, Roller, Distributor Truck, Other) N/A if not Applicable

Plant Operators

Years of Experience:

If yes, list the positions and time you held each one:
N/A if not Applicable

Give a brief explanation of experience at:
N/A if not Applicable

Concrete Crew

List any of the following concrete work you have performed such as Structural; Flat Work; Curb & Gutter; and Paving:
N/A if not Applicable

Other concrete work:
N/A if not Applicable

Select positions you have previously held such as Laborer; Form Setter; Finisher; Slip Forming; and Paving Crew:
N/A if not Applicable

Please give details of your concrete work experience:
N/A if not Applicable

Conclusion

List Former Employers and Dates Worked:

Do You have any objection to working out of town for the duration of construction projects? Yes No

Additional information you would like to tell us about yourself?

N/A if not Applicable

Completion of this section is required to satisfy federal equal employment opportunity statistical reporting.

This section WILL BE detached from the application and used only for said statistical reporting.

Social Security Number Present Age

Sex: Male Female

Ethnic Group: White Black Hispanic Native American Asian
Other

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