Full Name

Date

Position Applied For: Position Applied For: Estimator/PM (Idaho) General Operator (Idaho) Motor Grader Operator (Idaho) CDL Driver/Operator (Idaho) Laborer (Idaho) Transport Driver (Idaho) Water Truck Driver (Idaho) End Dump Driver (Idaho) Mechanic (Idaho) General Operator (Wyoming) Motor Grader Operator (Wyoming) End Dump Driver (Wyoming) Laborer (Wyoming) Mixer Truck Driver (Wyoming) Paving Operator (Wyoming) Water Truck Driver (Wyoming)

Address

City

State

Zip Code

Date of Birth

Phone Number

Email Address

Are you legally authorized to work in the United States? Are you legally authorized to work in the United States?YesNo

If you are under age 18, do you have an employment/age certificate? If you are under age 18, do you have an employment/age certificate?YesNo

Have you been convicted of or pled no contest to a felony within the last five years? Have you been convicted of or pled no contest to a felony within the last five years?YesNo

If yes, please explain:

What date are you available to start work?

Please list your previous employment, starting with the most recent:

1. Previous Employer Name

Job title

Dates of Employment (please include start and end date)

Responsibilities

Reason for Leaving

2. Previous Employer Name

Job title

Dates of Employment (please include start and end date)

Responsibilities

Reason for Leaving

Skills and Qualifications Skills and Qualifications Valid CDL License Heavy Equipment Experience Motor Grader Operation End Dump Truck Driving Water Truck Driving Skid Steer Operation Backhoe Operation Loader Operation Roller Operation Asphalt Work/Paving Mechanic Experience

Other Skills (Please Specify)

High School Name

High School Graduation Date

College/Trade School Name (if applicable)

College/Trade School Graduation Date

College/Trade School Degree/Certification

Please provide two professional references (not relatives)

1. Reference Name

Relationship

Phone Number

Email

2. Reference Name

Relationship

Phone Number

Email

Please provide any additional information relevant to your application (e.g., certifications, additional skills, why you are interested in this position, etc.)

By signing my name here, I certify that the information provided in this application is true and accurate to the best of my knowledge. I understand that any false or misleading information may result in the rejection of my application or termination of my employment if hired.

Date of Signature

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. We consider applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, marital, or veteran status, or any other legally protected status. WE ARE A DRUG FREE WORK PLACE. We require pre-employment, post accident, reasonable suspicion and random testing. If you are tested for employment and work less than thirty days you will be responsible for the cost of testing. I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above. Please sign your name here.

Full Name

Date

List all licenses held in the past 3 years.

1. State

License #

Class

Endorsements

Expiration Date

2. State

License #

Class

Endorsements

Expiration Date

3. State

License #

Class

Endorsements

Expiration Date

4. State

License #

Class

Endorsements

Expiration Date

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

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

. Have you ever been disqualified for violations of the Federal Motor Carrier Safety regulations? . Have you ever been disqualified for violations of the Federal Motor Carrier Safety regulations?YesNo

If you answered "yes" to any of the above questions, please include full details.

Please provide details of your driving experience. Include the class of Equipment you operated (straight truck, tractor & semi trailer, twin trailers - LVC's, other), the type of equipment (van, tank, flat, etc.), approximate total miles you drove, and the start and end dates you drove that equipment.

List States operated in during the last five (5) years

List special courses or training that will help you as a driver

List the accidents you have been involved in the past three years. Include the dates, the nature of the accident (head on, rear end, overturn, etc.), fatalities, and injuries.

List any Traffic Convictions or Forfeitures for the past three years other than parking violations. Include the date, location (city and state), charge, and penalty.

By signing here, I certify that this employment application was completed by me, and that all information in it are true and accurate to the best of my knowledge.