Driver Application Employment Application for Driver's with American Concrete Step 1 of 6 16% CompanyThis field is for validation purposes and should be left unchanged.Personal InformationYour Name(Required) First Last Social Security No.(Required)Date of Birth(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email Address(Required) Mobile Phone Number(Required)Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code What type of drivers license do you have?(Required) CDL Non-CDL State(Required) State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Driver's License No.(Required)Date of Issue(Required) MM slash DD slash YYYY Expiration Date(Required) MM slash DD slash YYYY Upload a copy of your driver's license (DRIVERS LICENSE ONLY)(Required)Max. file size: 512 MB. Do you have a valid DOT medical card?(Required) Yes No File(Required)Max. file size: 512 MB. Employment InterestWhat position are you seeking?(Required)CDL DriverMechanicPlant Manager / BatcherSalesMinimum HOURLY Requirement(Required)Date Available for Work(Required) MM slash DD slash YYYY Background InformationHave you ever applied for work or been employed by this company?(Required) Yes No Specify location and approximate date.Have you ever been known by or used another name (married, maiden name etc.), specify name and date.(Required) Yes No Specify name and approximate date.Are you a US citizen?(Required) Yes No If no, what authorization do you have work in the US?Have you been involved in any motor vehicle accidents while driving in the last three years?(Required) Yes No If Yes, please explain.Have you been convicted of a felony?(Required) Yes No If Yes, please explain.Have you been convicted for driving while intoxicated, reckless driving, or possession of nonprescription drugs in the last three years?(Required) Yes No If Yes, please explain.Have you violated any motor vehicle laws or ordinances for which you were convicted or forfeited bond or collateral in the last three years? (excluding parking violations)(Required) Yes No If Yes, please explain.Have you ever had a license, permit, or privilege to operate a motor vehicle suspended, revoked, or denied?(Required) Yes No If Yes, please explain.Emergency Contact InformationIn case of emergency, please notify:(Required) First Last Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Emergency Contact Phone No.(Required)Relationship to Applicant(Required) Employment ExperienceYour Previous Employers(Required)Please list your last 3 years of previous employment. Company NameSupervisor's Name & TitlePhonePosition Add RemoveDate Started(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date Ended(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Company Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code List Job Title and explain duties(Required)Starting Hourly Pay(Required)Final Hourly Pay(Required)Reason for leaving(Required)Job Experience 1 Add Additional Employment Experience Next Previous Position(Required)Please list your previous employers, the dates you worked and the position you heldCompany NameSupervisor's Name & TitlePhonePosition Add RemoveDate Started(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date Ended(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Company Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code List Job Title and explain duties(Required)Starting Hourly Pay(Required)Final Hourly Pay(Required)Reason for leaving(Required)Job Experience 2 Add Additional Employment Experience Next Previous Position(Required)Please list your previous employers, the dates you worked and the position you heldCompany NameSupervisor's Name & TitlePhonePosition Add RemoveDate Started(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date Ended(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Company Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code List Job Title and explain duties(Required)Starting Salary(Required)Final Salary(Required)Reason for leaving(Required)Job Experience 3 Add Additional Employment Experience Next Previous Position(Required)Please list your previous employers, the dates you worked and the position you heldCompany NameSupervisor's Name & TitlePhonePosition Add RemoveDate Started(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date Ended(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Company Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code List Job Title and explain duties(Required)Starting Salary(Required)Final Salary(Required)Reason for leaving(Required)May we call your present employer now?(Required) Yes No If no, when may we call?Do you have an agreement with any current or former employers that in any way restrict future employment activities? If YES, please include a copy of the agreement.(Required) Yes No Employment AgreementMax. file size: 512 MB. Education, Activities, and Military RecordEducation RecordHigh School Name(Required)Date Started(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date Ended(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Did you graduate?(Required) Yes No If no, do you have a GED?(Required)Did you attend college, vocational school or technical school?(Required) Yes No Education Cont.(Required)Vocational/Tech School/CollegeMajor or Degree Conferred Add RemoveDate Started(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date Ended(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Did you graduate?(Required) Yes No Scholastic HonorsFellowships, Scholarships, special awards, etc.List Machines/Equipment you are qualified to operate and any other skills you possess.(Required)ActivitiesList any school, professional, trade, business or civic organizations in which you have participated and offices held.You may omit those that indicate age, sex, race, color, religion, national origin, physical or mental disability or status as a disabled veteran.List any special accomplishments or rewards.You may omit those that indicate age, sex, race, color, religion, national origin, physical or mental disability or status as a disabled veteran.Military RecordDid you serve in the United States Armed Forces?(Required) Yes No Military Service(Required)Branch of ServiceHighest Rank Attained Add RemoveDate Enlisted(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date Discharged(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Type of Discharge(Required) Honorable Under Honorable Conditions Under Other Than Honorable Conditions Bad Conduct Dishonorable Uncharacterized ReferencesPersonal ReferencesPlease list below any references we may contact.NameEmailPhone No. Add RemoveNameEmailPhone No. Add RemoveNameEmailPhone No. Add Remove AuthorizationsAs a condition of my employment with American Concrete, I understand that I must undergo and pass, to the company's satisfaction, a thorough investigation on educational background, employment experience, personal references, criminal/cival records, motor vehicle record check, and physical examination, including a drug screen. I hereby authorize and request that any of the above information be provided to the company. I authorize American Concrete to receive the results of drug tests and the purpose of this test is to make sure employee is within the DOT guidelines for employment. This consent is effective for the duration of employment.AuthorizationFor the release of personal data and record information.SignatureName(Required) First Last AcknowledgementsPlease read and initial each of the following:Misrepresentation(Required)I certify that all statements I have made in this application are true and agree that any misrepresentation or omission of facts requested may be sufficient cause for cancellation of my application or immediate dismissal from the Company if I have been employed. In the event I am employed, I agree to conform to the rules and policies of the Company. I understand that these rules and policies may be changed, withdrawn or added to at the Company's option at any time without notice. I agree.Federal Motor Carrier Safety Regulations(Required)I understand that Federal Motor Carrier Safety Regulations (Parts 383 and 391) require that every driver operating a commercial vehicle over 10,001 lbs, transporting more than 15 people, or hauling hazardous materials hold only one valid operator’s license. Drivers must report any suspension, revocation, or cancellation of their license to their employer by the next business day and notify both their employer and licensing state in writing of any traffic law violation (other than parking) within 30 days. I agree.Physical Requirement(Required)I understand that employment is contingent upon meeting the physical requirements of the job and passing, to the Company's satisfaction, a preemployment physical examination, which will include a drug screen. I agree.Background Investigation(Required)I acknowledge the Company's notification to me that a background investigation or an investigative consumer report on me may be made. I understand and agree that successful completion to the Company's satisfaction of such investigation(s) is required for employment or investigation(s) described above and to prepare or cause to be prepared a report based on such information. I further understand that, upon my written request, a complete disclosure of the nature and scope of the investigation(s) conducted will be provided to me. I agree.At Will Employment(Required)I understand that my employment may be terminated, with or without cause, and with or without notice, at any time, at the option of either the Company or myself. I acknowledge that I do not have a contract of employment unless such rights are made part of a written agreement executed by me and by a Vice President or higher level officer of the Company. I agree.Liability(Required)I agree that the Company's liability to me for wages is limited to the amount earned by me as of the date of such termination. I also authorize the Company to deduct at any time any monies owed by me to the Company whenever such deduction is not prohibited by law. I agree.Unauthorized Aliens(Required)I understand that federal law prohibits the employment of unauthorized aliens and that all persons hired must submit satisfactory proof of employment authorization and identity generally within three days of being hired. I further understand that the failure to submit such proof within the required time will result in my immediate dismissal from the Company if I have been employed. I agree.Disclosure(Required)I understand that my disclosure of prior convictions for criminal or traffic offenses will not necessarily prevent my employment with the Company; however, the omission of this requested information will be sufficient cause for cancellation of my application or my immediate dismissal from the Company. I agree.Agreement(Required)I have read and agree to the above acknowledgements. I agree.Upload Your Resume and any other supporting documentationUpload your resume in .pdf, .doc or .docx format Drop files here or Select files Accepted file types: pdf, doc, docx, Max. file size: 20 MB, Max. files: 5. Signature(Required)I have read and agree to the above authorizations.Date of Application(Required) MM slash DD slash YYYY
