Online Employment Application

Date*
MM slash DD slash YYYY
Name*
First Last
Phone*
Address*
Street Address City State ZIP Code
Have you been at the above residence less than 3 years?*
- Yes
- No

If yes, list all residences for the past 3 years:

Street	City	State	Zip Code

(Use + button to add more)

Do you have the legal right to work in the United States?*
- Yes
- No
Date of Birth*
MM slash DD slash YYYY
Can you provide proof of age? What type?*

Required for Commercial Drivers
In case of emergency, notify:*
First Last
Emergency Contact Phone*
Position(s) applying for:*

Please review open positions on our Employment page.
Type of hours:*
- Part-time
- Full-time
Who referred you?*
First Last
Rate of pay expected:*
Are you currently employed?*
- Yes
- No
If not, how long since leaving last employment?
Education
High grade completed:*
- 8
- 9
- 10
- 11
- 12
College:
- 1
- 2
- 3
- 4
Last school attended:*
List special courses or training that will help you as an employee:
General Information
Have you ever been convicted of a felony?*
- Yes
- No
If yes, please explain fully:
Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.
Physical History
Is there any reason you might not be able to perform the functions of the job for which you have applied?*
For drivers only: Date of last ICC physical examination:
Employment History
The U.S. Department of Transportation requires that driver applicants show all employment for the past three years. Effective July 1987, must also show commercial driver employment for the seven years immediately proceeding this three-year period. Section 391-21 (b) (10), (11).

Start with the last or current position, including military experience, and work back.
Current Employer
Contact Person
First Last
Address
Street Address City State ZIP Code
Phone
Position Held
Dates of employment:
Wage
Reason for leaving:
Did you drive a vehicle requiring a CDL?
- Yes
- No
Previous Employer
Contact Person
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Position Held
Dates of employment:
Wage
Reason for leaving:
Did you drive a vehicle requiring a CDL?
- Yes
- No
Previous Employer
Contact Person
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Position Held
Dates of employment:
Wage
Reason for leaving:
Did you drive a vehicle requiring a CDL?
- Yes
- No
Driver Experience & Qualifications
Have you ever been denied a license or privilege to operate a motor vehicle?*
- Yes
- No
If yes, please explain:
Has any license, permit, or privilege ever been suspended or revoked?*
- Yes
- No
If yes, please explain:
Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?*
- Yes
- No
If yes, please explain:
Class of Equipment: Straight Truck
Dates Driven Approx. Miles Driven
Class of Equipment: Tractor & Semi-Trailer
Dates Driven Approx. Miles Driven
Class of Equipment: Twin Trailers
Dates Driven Approx. Miles Driven
Class of Equipment
Other Dates Driven Approx. Miles Driven
List states operated in during the last five years:*
List special courses or training that will help you as a driver:
List safe driving awards help and who awards were presented by:
Do you have any accidents on record in the past 3 years?*
- Yes
- No

If yes, please explain:

Nature of Accident	Fatalities	Injuries

List most recent first. (Use + button to add more)

Have you had any traffic convictions or forfeiturers in the past 3 years?*
- Yes
- No
Other than parking violations.

If yes, please explain:

Location	Date	Charge	Penalty

(Use + button to add more)

Equipment Operator Experience & Qualifications

Equipment Operation Experience

Type of equipment operated	Dates operated from	Approx. Hours

(Use + button to add more)

List special courses that will help you as an operator:
Maintenance Experience & Qualifications
List courses and training in maintenance work:
Drive Line Components
Formal Training Experience
Diesel Engine Check
Formal Training Experience
Trailer Service Repair
Formal Training Experience
Brakes, including adjustment
Formal Training Experience
Inspections
Formal Training Experience
General Truck Repair
Formal Training Experience
Signature
It is understood and agreed that Dulas Excavating Inc. may investigate the applicant’s background to ascertain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employer and persons named herein from all liability for any damages on account of his/her furnishing such information.

It is also understood and agreed that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an Investigative Consumer Report, including information regarding my character, general 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 understand that this application is not an employment contract and that, if hired, my employment and compensation can be terminated, with or without cause, at any time at the option of either the company or myself.

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.
Date*
MM slash DD slash YYYY
Signature*
Phone
This field is for validation purposes and should be left unchanged.

Education

General Information

Physical History

Employment History

Driver Experience & Qualifications

Equipment Operator Experience & Qualifications

Maintenance Experience & Qualifications

Signature

Social

Contact

Links

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