EMPLOYMENT APPLICATION

APPLICANT

Today's Date:(*)

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First Name(*)

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Middle Initial

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Last Name(*)

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Street Address(*)

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Apartment #

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City(*)

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State(*)

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Zip(*)

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Home Phone(*)

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Cell Phone

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Please let us know your email address.

Are you currently employed?(*)

Yes

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Position Applying For:

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How did you find out about this job?

Newspaper

Internet

Referral

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Desired Starting Rate / Hour $

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Special Training, skills: (*)

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Date Available to Start:

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EDUCATION

High School

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Did you graduate?

Yes

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Number of Years Attended:

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Received:

Diploma

GED

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College

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Did you graduate?

Yes

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Number of Years Attended

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Degree Acquired:

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VoTech

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Did you graduate?

Yes

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Number of Years Attended

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Degree Acquired:

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MILITARY SERVICE

Branch:

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From:

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To:

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Rank at Discharge:

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Type of Discharge:

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If other than honorable, explain:

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EMPLOYMENT HISTORY

Start with most recent employer first.

EMPLOYER 1

Company

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Address:

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Supervisor:

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Phone

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Position Held

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Starting Salary:

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Ending Salary:

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Describe Your Duties

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Starting Date:

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Ending Date:

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Reason for Leaving

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May we contact your previous supervisor for a reference?

Yes

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Comments:

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EMPLOYER 2

Company

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Address:

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Supervisor:

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Phone

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Position Held

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Starting Salary:

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Ending Salary:

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Describe Your Duties

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Starting Date:

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Ending Date:

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Reason for Leaving

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May we contact your previous supervisor for a reference?

Yes

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Comments:

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EMPLOYER 3

Company

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Address:

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Supervisor:

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Phone

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Position Held

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Starting Salary:

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Ending Salary:

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Describe Your Duties

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Starting Date:

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Ending Date:

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Reason for Leaving

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May we contact your previous supervisor for a reference?

Yes

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Comments:

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REFERENCES

Please list three professional references that are not related to you and are not previous employers.

REFERENCE 1

Name:

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Address/City/State/ZIP

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Company:

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Phone

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Relationship:

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REFERENCE 2

Name:

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Address/City/State/ZIP

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Company:

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Phone

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Relationship:

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REFERENCE 3

Name:

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Address/City/State/ZIP

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Company:

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Phone

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Relationship:

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FOR DOT CERTIFIED DRIVERS

Do you have a valid driver's license:

Yes

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Issuing State:

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Driver's License#:

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Expiration:

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Class:

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CDL Endorsement(s):

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

Yes

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Has any license, permit or privelege ever been suspended or revoked to operate a motor vehicle in the past 3 years?

Yes

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If you answered yes to either of the above questions, please provide a statement giving details:

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TRAFFIC CONVICTIONS

List all violations of motor vehicle laws(other than parking violations) resulting in conviction or forfeited bond or collateral during the past three years:

Date:

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Date:

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Date:

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Location:

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Location:

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Location:

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Charges:

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Charges:

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Charges:

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Penalty:

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Penalty:

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Penalty:

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ACCIDENT RECORD

For the past three years. - If none, write "NONE"

DRIVING & OPERATING EXPERIENCE

Please check the types of motor vehicles and equipment you have driven and list the approximate length of time you have actually operated the vehicle or equipment.

Straight Truck

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Tractor & Semi

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Single Axle Truck

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Tri-Axle Truck

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Low Boy

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End Dump

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Side Dump

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Fuel Truck

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Water Truck

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Paver

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Compactor

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Roller

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Loader

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Skid Loader

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QUALIFICATIONS

List any special courses or traing you have completed:

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List any safe driving awards you have received, and from whom:

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List any trucking or other relevant experience:

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List knowledge, skills and abilities not listed above that you possess, and are relevant to the position you seek:

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UPLOAD RESUME

Attach Resume

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PLEASE READ CAREFULLY BEFORE SIGNING.

The information I have provided in this application for Employment is true, correct and complete to the best of my knowledge. I certify that I have answered all questions to the best of my ability and have not withheld any information that would unfavorably effect my application for employment. I acknowledge that misrepresentation or omissions may be the cause for my rejection for employment or may result in my subsequent dismissal if I am hired.

I hearby consent to have Hager Paving, Inc. contact anyone it deems appropriate to investigate or verify any information I have provided or to discuss my background, past performance or suitability for employment. I expressly consent to any discussions regarding the foregoing by any person contacted. I knowingly and voluntarily waive all rights to bring any actions for defamation, invasion of privacy or similar cause of action against anyone providing such information.

I understand that employment at Hager Paving, Inc. is "at-will", which means that either I or Hager Paving, Inc. can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no leader, supervisor, manager or executive of Hager Paving, Inc. other than the President or Vice-President (by signature) has the authority to create an employment contract other than an at-will employment contract.

Enter Your Full Name(*)

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Today's Date:(*)

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Career Opportunities

EMPLOYMENT APPLICATION

APPLICANT

EDUCATION

MILITARY SERVICE

EMPLOYMENT HISTORY

EMPLOYER 1

EMPLOYER 2

EMPLOYER 3

REFERENCES

REFERENCE 1

REFERENCE 2

REFERENCE 3

FOR DOT CERTIFIED DRIVERS

TRAFFIC CONVICTIONS

ACCIDENT RECORD

DRIVING & OPERATING EXPERIENCE

QUALIFICATIONS

UPLOAD RESUME

Call Us Today:

Career Opportunities

EMPLOYMENT APPLICATION

APPLICANT

EDUCATION

MILITARY SERVICE

EMPLOYMENT HISTORY

EMPLOYER 1

EMPLOYER 2

EMPLOYER 3

REFERENCES

REFERENCE 1

REFERENCE 2

REFERENCE 3

FOR DOT CERTIFIED DRIVERS

TRAFFIC CONVICTIONS

ACCIDENT RECORD

DRIVING & OPERATING EXPERIENCE

QUALIFICATIONS

UPLOAD RESUME

APPLICANT'S STATEMENT OF CONSENT