Employment Application

12354 44th St N

Clearwater, FL 33762

Schedule Service

(727) 573-4683

Email Us

office@concreteoncall.com

If you have lived at the above residence for less than 3 years, list your previous residence.

Previous Street Address

Position Applying For

Do you have RELIABLE TRANSPORTATION to and from work?

Yes No

Work starts at 6:00am, would there be any conflicts that would prevent you from making to work on time?

Yes No

Concrete on Call works Monday-Saturday, do you have any problems working Saturday?

Yes No

If answered YES above, please explain.

Are you a citizen of the United States?

Yes No

If No, are you authorized to work in the U.S.

Yes No

Have you ever been convicted of a felony?

Yes No

If yes, Please Explain.

The Federal Motor Carrier Safety Regulations 49CFR40.25(j) requires all persons when applying for a driving position requiring a commercial driver's license to answer the following questions:

Within the last two years, have you ever tested positive, or refused to test, on any pre-employement drug or alcohol test administered by an employerto which you applied for, but did not obtain, safety-sensitive transportation work?

Yes No

Within the last two years, have you ever tested positive, or refused to test, on any drug or alcohol test administered by an employer for which you preformed safety-sensitive transportation work?

Yes No

If yes to either of the two above questions, can you provide and/or obtain proof that you have successfully completed the DOT return-to-duty requirements?

Yes No

Previous Employment

Please provide previous employment for the past 3 years starting with the most recent or current position first.

May we contact your previous supervisor for a reference?

Yes No

May we contact your previous supervisor for a reference?

Yes No

May we contact your previous supervisor for a reference?

Yes No

Did you graduate?

Yes No

Did you graduate?

Yes No

Did you graduate?

Yes No

If other than honorable, please explain

Describe any military training recieved that is relevant to the applied position:

Are you currently serving in the Military Reserves?

Yes No

Are you currently serving in the National Guard?

Yes No

The Federal Carrier Safety Regulations (49CFR391 Subpart E) require that all driver applicants pass certain physical tests before they are hired to drive a motor vehicle.

Date of last Department of Transportation Prescribed examination

Have you ever been granted a waiver under section 391.49 of the Federal Motor Carrier Safety Regulations pertaining to the loss of foot, leg, hand, or arm?

Yes No

Drivers License Number

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

Yes No

Has any license, permit, or privilege ever been suspended or revoked?

Yes No

Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?

Yes No

If yes to any of the three questions above , please provide details.

Please provide all of your driving experience and list any experience with machinery: (include: Class of Equipment, Type of Equipment (i.e. van, tank, flat, loader, etc.), Start and End Dates, Approximate Total Miles)

Accident History for the past 3 years (include: Date, Citation Issued, Nature of the Accident, # of Cars Towed, # of injurie, # of Fatalities)

Insurance Drivers Guidelines

Our insurance requires all driving employees to meet the minimum driver record standards below. Please answer honestly

Any major* violations in the last 60 months?

Yes No

Any minor* moving violations in the last 36 months?

Yes No

Any at-fault accidents within the last 36 months? (all accidnets are consideres at-fault unless there is written documentation to the contrary)

Yes No

Any "incidents" within the last 36 months? (an "incident" is a minor non-moving violation or not-at-fault accident)

Yes No

Are you at least 21 years of age? (all drivers operating light to medium units must be 21 or older)

Yes No

All drivers operating heavy and extra-heavy trucks must have a valid CDL license and must be 23 years of age with a minimum of 2 years driving experience, do you meet these requirements?

Yes No

If yes to the first 4 questions, please explain:

Disclaimer and Signature

I certify that I have read and understand all of this employment application. It is agreed and understood that the employer or his agents may investigate the applicant's background, including but not limited to running the drivers license, to ascertain any and all information of concern to the applicant's record, whether same is of record or not, and applicant releases employers and other persons names herein from all liability for any damages on account of his/her furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, this investigation may include an investigative Consumer Report, including information regarding my character, personal reputation, personal characteristics, and mode of living.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal.

If hired, I agree to abide by all the rules and policies of the employer. Attached you will find the driver guidelines for Concrete-on-call. By signing below, you certify that you comply with all their guidelines.

This certifies that I completed this application and that all entries on it and information in it are true and complete to the best of my knowledge.

12354 44th St N

Clearwater, FL 33762

Schedule Service

(727) 573-4683

Email Us

office@concreteoncall.com

About Us

Concrete On-Call specializes in delivering volumetric concrete for construction projects small to large.

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Application Submitted!

Thank you for your interest in employment with Concrete on Call. We will review your application and inform you of our decision soon.

12354 44th St N

Schedule Service

Email Us