Application: Laborer

Applicant Information

Name

First Middle Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Date of Birth(Required)

Desired Salary

Position Applying For

Social Security Number

Are You a Citizen of the United States?

Yes

No

If No, Are You Authorized to Work in the United States?

Yes

No

Have You Ever Worked for Davids Hydro Vac?

Yes

No

If Yes, When?

Previous Three Years Residency

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date (From)

Date (To)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date (From)

Date (To)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date (From)

Date (To)

License Information

Section 383.21 FMCSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license." I certify that I do not have more than one motor vehicle license, the information for which is listed below.

Driver's License State & Number

Expiration Date

Driver's License Class

A

B

D

Endorsements/Restrictions – Explain:

Accident Record for past 3 years or more 5 years –(Explain)

Accident Record for past 3 years or more 5 years –(Detail)

Dates

Nature of Accident

Number Fatalities

Number Injuries

Chemical Spills Y/N

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 5 YEARS (OTHER THAN PARKING VIOLATIONS)

Date Convicted

Violation

State of Violation

Penalty

Do we have your permission to run your MVR:

Yes

No

Have you ever been denied a license, permit or privilege to operate a motor vehicle? YES NO If yes, please explain

If yes, please explain

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

If yes, please explain

Education - High School

High School Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

From:

To:

Did You Graduate?

Yes

No

Education - College

College Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

From:

To:

Did You Graduate?

Yes

No

Degree

Education - Other

Other Institution Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

From:

To:

Did You Graduate?

Yes

No

Degree

Reference #1

Please list three professional references.

Full Name

Relationship

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference #2

Full Name

Relationship

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference #3

Full Name

Relationship

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Previous Employer #1

Please provide three previous employers.

Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years. You must give the same information for all employers you have driven a commercial motor vehicle for the seven years prior to the initial three years (total of ten years employment record).

Must list the complete mailing address: street number and name, city, state and zip code.

Gap Explanation: (explain any 30+ day gap from last employer to present)

Company

Job Title

Supervisor

From:

To:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Starting Salary

Ending Salary

Roles & Responsibilities

Reason for Leaving

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer? YES NO If yes, please provide the regulated vehicle(s) driven:

If yes, please provide the regulated vehicle(s) driven:

List

Class of Equipment

Type of Equipment (Van, Tank, Flat, Etc)

Dates Driven During Employment (From To)

Approximate Number of Miles Total

May we contact your previous supervisor for a reference?

Yes

No

Previous Employer #2

Gap Explanation: (explain any 30+ day gap from last employer to present)

Company

Job Title

Supervisor

From:

To:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Starting Salary

Ending Salary

Roles & Responsibilities

Reason for Leaving

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer? YES NO If yes, please provide the regulated vehicle(s) driven:

If yes, please provide the regulated vehicle(s) driven:

List

Class of Equipment

TYPE OF EQUIPMENT (VAN, TANK,FLAT,ETC)

DATES DRIVEN DURING EMPLOYMENT

APPROXIMATELY NUMBER OF MILES TOTAL

May we contact your previous supervisor for a reference?

Yes

No

Previous Employer #3

Gap Explanation: (explain any 30+ day gap from last employer to present)

Company

Job Title

Supervisor

From:

To:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Starting Salary

Ending Salary

Roles & Responsibilities

Reason for Leaving

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer? YES NO If yes, please provide the regulated vehicle(s) driven:

If yes, please provide the regulated vehicle(s) driven:

List

Class of Equipment

TYPE OF EQUIPMENT (VAN, TANK,FLAT,ETC)

DATES DRIVEN DURING EMPLOYMENT

APPROXIMATELY NUMBER OF MILES TOTAL

May we contact your previous supervisor for a reference?

Yes

No

Military Service

Branch

From:

To:

Rank at Discharge

Type of Discharge

If Other Than Honorable, Please Explain:

Supplemental Questionnaire

Do you have a clean driving record for the last 5 years? If not, please explain.

Do you have any experience in outdoor work environments such as construction/landscaping, utilities, etc? We work year round in all weather conditions.

Do you have – or are you willing to obtain – a CDL-A license within 2 months of joining our team?

Attendance is paramount at DHV, do you have reliable transportation to and from our White Bear Lake or Lakeville facilities?

Do you have a mechanical aptitude? Part of the laborers position is to help recognize mechanical issues before they become a problem, grease the equipment and perform small maintenance tasks, etc.

Do you have any equipment experience such as skid steer loaders?

Are you willing to travel? Our line of work has travel requirements of 1-6 weeks at a time depending on customer needs.

Disclaimer & Signature

I authorize you to make sure investigations and inquiries to my personal, employment, financial, or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended). I hereby release employers, schools, healthcare providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. 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. I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23 (d) and (e.) I understand that I have the right to: • Review information provided by current/previous employers; • Have errors in the information corrected by previous employers and for those previous employers to 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.

Date

CAPTCHA

Note: A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations.

Untitled

List

Employment Application

Applicant Information

Previous Three Years Residency

License Information

Education - High School

Education - College

Education - Other

Reference #1

Reference #2

Reference #3

Previous Employer #1

Previous Employer #2

Previous Employer #3

Military Service

Supplemental Questionnaire

Disclaimer & Signature