test

 


Employment Application


 

Last Name: [last_name] First Name: [first_name] Middle Name: [middle_name]
Current Address: [cur_address] Telephone Number: [tel_number]
City: [city] State: [state] Zip Code: [zip_code] Country: [country]
Are you legally eligible to work in the United States?

[experience]

If offered a position, you will be required to produce evidence of your identity and employment eligibility.

What are your salary/wage expectations?

[salary]/ Hour Year

When would you be able to start work?

[s_work]

Are you 18 years or older?

[ask_age]

In accordance with FMCSR, to operate a Commercial Motor Vehicle (CMV) interstate you need to be at least 21 years of age. Only complete if applicable to the job you are applying for.

[ask2_age]

Have you ever been employed by Tech Con Trenching Inc. and or affiliate? If so what company and what date?

[affiliate]

Do you have any relatives that work for Tech Con Trenching Inc.

[relatives_works]

Do you have a valid drivers license?
As applicable to the job you are applying for.
[val_drivers]
Have you ever been denied a license, permit, or Driving privileges. [den_license]
Has any license, permit, or driving privileges Ever been suspended or revoked?
If yes please explain:
[lic_suspended]


[lic2_suspended]

Are you able to perform job essential functions for which you are applying for. [job_essential]
What Position are you applying for? [job-position]

 


Education and Certifications


 

School Name: Location Years Attended GED, Diploma or Degree
High School: [high_hchool_name] [high_hchool_loc] [high_hchool_years] [high_hchool_deg]
College or University: [university_name] [university_loc] [university_years] [university_deg]
Other (Technical, vocational, Business, etc.: [technical_name] [technical_loc] [technical_years] [technical_deg]
List any achievements, awards, honors: [list__name] [list__loc] [list__years] [list__deg]
List any certifications, training, or skills
you feel are applicable to the job being applied for.
Please provide any certifications and documentation/certificates you may have

[certifications_doc]

Additional Document
[certifications]
Additional Document 1
[certifications1]

Expiration Dates

[certifications_exp]

 


Employment History


 

Instructions: Please list your employer(s) for the past three years, listing the most recent employer first. Any gaps in employment and/or unemployment must be explained. If additional space is required, please enter on a separate sheet.

  • CDL Drivers, please list your employers for the past ten years, listing the most recent employer first.

When answering questions A and B, please refer to the following information.

  • The Federal Motor Carrier Safety Regulations (FMCSR’s) apply to anyone operating a motor vehicle on a highway in interstate/intrastate commerce to transport passengers or property when in the vehicle (1) weighs or has a GCWR of 10,001 pounds or more, (2) is designed or used to transport 9 or more passengers, OR (3) is any size and is used to transport hazardous materials in a quantity requiring placarding.

 

Work Ended
[work_end_month]

Month

[work_end_year]

Year

Work Began
[work_began_month]

Month

[work_began_year]

Year

Company Name: [h_company_name] Position Held: [h_position_held]
Address: [h_address] Phone Number: [h_pnumber]
Supervisors Name: [h_sname] Supervisor phone Number: [h_snumber]
Reasons For Leaving: [h_reason_leaving]

 

A. Were you subject to FMCR’s while employed? [fmcr_employed]

 

B. Was your job designated as a safety-sensitive function in any DOT- regulated mode subject to drug and alcohol testing requirements of 49 CFR Part 40? [job_designated]

 

Account for Period between Jobs with Reason (If applicable) From To (Current)
[h_job_reason] [from_month_year]
Month/year
[to_month_year]
Month/year

 

Work Ended
[work_end_month2]

Month

[work_end_year2]

Year

Work Began
[work_began_month2]

Month

[work_began_year2]

Year

Company Name: [h_company_name2] Position Held: [h_position_held2]
Address: [h_address2] Phone Number: [h_pnumber2]
Supervisors Name: [h_sname2] Supervisor phone Number: [h_snumber2]
Reasons For Leaving: [h_reason_leaving2]

 

A. Were you subject to FMCR’s while employed? [fmcr_employed2]

 

B. Was your job designated as a safety-sensitive function in any DOT- regulated mode subject to drug and alcohol testing requirements of 49 CFR Part 40? [job_designated2]

 

Account for Period between Jobs with Reason (If applicable) From To (Current)
[h_job_reason2] [from_month_year2]
Month/year
[to_month_year2]
Month/year

 

Work Ended
[work_end_month3]

Month

[work_end_year3]

Year

Work Began
[work_began_month3]

Month

[work_began_year3]

Year

Company Name: [h_company_name3] Position Held: [h_position_held3]
Address: [h_address3] Phone Number: [h_pnumber3]
Supervisors Name: [h_sname3] Supervisor phone Number: [h_snumber3]
Reasons For Leaving: [h_reason_leaving3]

 

A. Were you subject to FMCR’s while employed? [fmcr_employed3]

 

B. Was your job designated as a safety-sensitive function in any DOT- regulated mode subject to drug and alcohol testing requirements of 49 CFR Part 40? [job_designated3]

 

Account for Period between Jobs with Reason (If applicable) From To (Current)
[h_job_reason3] [from_month_year3]
Month/year
[to_month_year3]
Month/year

 

Work Ended
[work_end_month4]

Month

[work_end_year4]

Year

Work Began
[work_began_month4]

Month

[work_began_year4]

Year

Company Name: [h_company_name4] Position Held: [h_position_held4]
Address: [h_address4] Phone Number: [h_pnumber4]
Supervisors Name: [h_sname4] Supervisor phone Number: [h_snumber4]
Reasons For Leaving: [h_reason_leaving4]

 

A. Were you subject to FMCR’s while employed? [fmcr_employed4]

 

B. Was your job designated as a safety-sensitive function in any DOT- regulated mode subject to drug and alcohol testing requirements of 49 CFR Part 40? [job_designated4]

 

Account for Period between Jobs with Reason (If applicable) From To (Current)
[h_job_reason4] [from_month_year4]
Month/year
[to_month_year4]
Month/year

 

References
If you did not provide references in your employment history. List three individuals who have knowledge of your occupation, skill and background
Name:

[ref_name]

[ref_name2]

[ref_name3]

Telephone Number:

[ref_number]

[ref_number2]

[ref_number3]

Occupation:

[ref_occupation]

[ref_occupation2]

[ref_occupation3]

Length of time Known:

[ref_time]

[ref_time2]

[ref_time3]

 

Are you willing to travel for the position applied for? [willing_travel]

 


EEO: Affirmative Action Self-Identifier Form


 

Here at Tech Con Trenching Inc. we are an Equal Oppurtunity Employer. As required by law, we must record certain information as part of our Affirmative Action Program. Applicants for employment are invited to complete this informattional form. You are advised that (a) you are under no obligation to respond but may do so in the future, (b) responses will remain confindential, and (c) responses are only used to provide necessary information included in the Affirmative Action reporting. Refusal to provide this information will have no effect on your application of employement.

 

Personal Information

 

Position applying for:[info_papplying]Application Date:[info_application]

Name: [info_name]
Date of Birth: [info_birthdate] City/State you were born: [info_cstate]

 


Ethnicity

 

Please check all that apply


 

[ [check-1] ] :White (not Hispanic or Latino). Persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.
[ [check-2] ] :Black or African American (not Hispanic or Latino) Persons having origins in any of the black racial groups of Africa.
[ [check-3] ] :American Indian or Alaskan Native (not Hispanic or Latino) persons having origins in any of the peoples of North and South America, including Central America, who maintain affiliation with tribal community.
[ [check-4] ] :Asian (not Hispanic or Latino) Chinese/Chinese American persons having origins in any of the original people of China. Japanese/Japanese American persons having origins in any of the original people of Japan.  Filipino/pilipino persons having origins in any of the original people of the Phillipine Islands. Pakistani/East Indian persons having origins of the original people of the Indian subcontinent Other Asain persons having origins in any of the original people of the Far East ( including Korea, Malaysia, Cambodia, Thailand, and Vietnam) and Southeast Asia.
[ [check-5] ] :Native Hawaian or Other Pacific Islander (not Hispanic or Latino) perosn having origins in any of the original people of Hawaii, Guam, Samoa, or other Pacific Islands.
[ [check-6] ] :Hispanic or Latino (including black individuals whose origins are Hispanic). Mexican/Mexican-American/Chicano person of the Mexican culture or origin, regardless of race Latin-American/Latino personof the Latin America (e.g. Central American, South American, Cuban, Peurto Rican) culture of origins regardless of race. Other Spanish/Spanish American person of Spanish Cuture or origin not included in the Hispanic categories above.
[ [check-7] ] :Multi Racial person who identify with more than one of the above races/ethnicities
[ [check-8] ] :I choose not to answer

 


Gender


 

[ [check-9] ] :Male [ [check-10] ] :Female
[ [check-11] ] :I choose not to answer

 


Veteran Status


 

[ [check-12] ] :Vietnam Era Veteran [ [check-13] ] :Other Eligible Veteran [ [check-14] ] :Special Disabled Veteran [ [check-15] ] :I choose not to answer

 


Employment Statement


 

An Equal Oppurtunity Employer

 

Tech Con Treniching Inc.and its affiliates provide equal oppurtunity employment opportunities (EEO) to all employees and applicants for employment withiout regard to race, color, religion, sex, nationality, age, disability, or genetics. In addition to federal law requirements, Tech ConTrenching Inc. complies with applicable state and local laws govening nondiscrimination in employment.

 


Please read the following statement before signing

 

I understand that the informaton I provided regarding current and/or previous employmers may be used and those employer(s) will be contacted, for the purpose of investigating my safety peformance history as requred by 49 CFR 391.23(d) and (e). I understand that I have the right to:

  • Review information provided by current and previous employers:
  • Have errors in the information corrected by previous employers and for thos previous employers ro re-send the corrected information to the prospective employer, and
  • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.”

I understand that the Hiring process may require interviews, written test, and job demonstration.  I agree that I will state whether I need any reasonable accommodations for the job selection procedures.

I understand and agree that I will participate in a Drug and Alcohol test and a physical examination if a job offer is made and that my employment is contingent on satisfactory completion of the test and the exam.

Futhermore, I undertstand that the misrepresentation or omission of requested information may result in my disqualification of employment or dismissal from employment process.

This application is not an employment contract. Any offer of employment will be on an employment at will basis. This means that I will not have an express or implied employment contract and that both the employer and I will have the right to terminate my employment at any time and for any reason

My Signature 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.

 

Name(printed): [butt_name] Date: [butt_date]

Signature: [butt_signature]

 


 

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