Employment Application Please answer all questions on this application, put N/A in the text box of questions that are not applicable.Where did you hear about this opportunity?(Required)FacebookLinkedInGeorgia Department of LaborJob FairWord of MouthPaper AdBillboardOtherJob Applying For(Required)Professional Delivery Tech (with CDL)SalespersonCustomer Service RepresentativeLoader OperatorPlant ManagerIT Support SpecialistParts ClerkDiesel MechanicIf other, please specify the position you are interested in. Name(Required) First Middle Last Social Security No.(Required) Phone(Required)Email Address(Required) Present Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench 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Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country How long have you lived there?(Required) Previous Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country How long did you live there?(Required) Date Available(Required) MM slash DD slash YYYY Salary DesiredType of employment(Required) Full-Time Part-Time If Part-Time, specify days and hour available.(Required) GeneralIf Hired, can you provide proof that you are legally entitled to work in the U.S.?(Required) Yes No Have you ever worked for Wayne Davis Concrete before?(Required) Yes No If yes, where and what dates where you employed?(Required) Position and Reason for leaving(Required) Do you have friends or relatives that work at Wayne Davis Concrete?(Required) Yes No If yes, please state name and relationship(Required) Who referred you?(Required) How would you get to and from work?(Required) Do you have commitments to any other employer?(Required) Yes No If yes, please explain.(Required) Do you have any limitations which would prevent you from performing specific kinds of work?(Required) Yes No If yes, please explain.(Required) Have you ever been convicted of a felony?(Required) Yes No If yes, please explain.(Required)Conviction of a crime is not an automatic bar to employment - All circumstances may be considered. Have you ever been convicted of a misdemeanor?(Required) Yes No If yes, please explain.(Required)Conviction of a crime is not an automatic bar to employment - All circumstances may be considered. Have you ever been bonded?(Required) Yes No Name of company you worked for when bonded:(Required) Name of company which bonded you.(Required) Have you ever been rejected by a bonding company?(Required) Yes No If yes, give name of company.(Required) Have you ever been discharged from any positions?(Required) Yes No If yes, give particulars(Required) Employment RecordThe U.S. Department of Transportation requires that driver applicants show all employment for the past three years. Effective July 1987 they must also show commercial driver employment for the seven years immediately preceding this three year period.Employment History (dates must be consecutive years)(Required)*If you need more spaces, please click the "plus" button*Dates of EmploymentName and Addres of EmployerRate of Pay (Start to Finish)Supervisor Name and TitleReason for leaving Add RemoveHave you ever served in the U.S. armed forced?(Required) Yes No If yes, what branch?(Required) Dates Served:(Required) Rank(Required) Service Serial No.(Required) Type of Discharge:(Required) Reserve or National Gaurd Status?(Required) EducationPlease select your highest level of eduction:(Required) Elementary High School College/University Graduate/Professional Trade/Correspondence/Craft Please list any degrees or certifications:(Required) Please list any other experiences, skills or qualifications which you feel would make you fit for work with Wayne Davis Concrete:(Required) Personal References(Required)Please list persons you know well - Not previous employers or relatives. If you need more spaces, please click the "plus" button.NameOccupationAddressPhone NumberNumber of years known Add RemoveDriver Experience & QualificationsDate of Birth(Required)The U.S Department of Transportation requires that applicants state their date of birth. MM slash DD slash YYYY Social Security No.(Required)License(Required)Driver's License No.Type of License HeldState Add RemovePhysical HistoryThe U.S Department of Transportation requires that all applicants pass certain physical tests before they are hired to drive a motor carrier.Date of last DOT prescribed physical exam.(Required) Have you ever been granted a waiver under section 391.49 Federal Motor Carrier Safety Regulations pertaining to the loss of foot, leg, hand or arm?(Required) Yes No Licenses(Required)Drivers Licenses held in the past 3 years must be shown If you need more spaces, please click the "plus" button.StateLicense No.TypeExpiration Date Add RemoveHave you ever been denied a license, permit or privilege to operate a motor vehicle?(Required) Yes No Has any license, permit or privilege ever been suspended or revoked?(Required) Yes No Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?(Required) Yes No If you answered yes to any of the questions above, please give details:(Required) Driver Experience(Required)If you need more spaces, please click the "plus" button.Class of EquipmentType of EquipmentDatesApproximate Total Miles Add RemoveList special courses or training that will help you as a driver(Required) List safe driving awards help and who presented awards(Required) List states operated in during the last five years(Required) Accident Review for past 3 years(Required)If you need more spaces, please click the "plus" button.DatesNature of accidentFatalitiesInjuries Add RemoveTraffic Convictions and Forfeitures for the past 3 years other than parking violations.(Required)If you need more spaces, please click the "plus" button.LocationDateChargePenalty Add RemoveMaintenance Experience & QualificationsList any courses or training in maintenance work(Required) Indicate training and experience in the following: Body Work Electrical Repair Frame and Wheel Alignment Inspections General Car Repair - Drive Line Components Diesel Engine Tune-up and Rebuild Tire Service Trailer Repair Air Conditioning - Cooling System Brakes Indicate training and experience in the following: Electrical Welder Oxyacetylene Welder Paint Spray Gun Tire Servicing Machine Wheel & Tire Balancing Machine - Electrical Equipment Diagnostic Sheet Metal Equipment Frame and Axle Straightening Equipment Engine Rebuilding Equipment Diesel Injection Equipment - Tire Recapping Machine Chassis Dynamo-meter Magnetic Crack Detector Engine Analyzer Noise Measuring Equipment Clerical Experience & QualificationsList any courses or training in office work(Required) Indicate training and experience in the following: Typing (WPM) Shorthand (WPM) Billing Filing Key Punch - Dictating Machine Booking Machine Switch Board Equipment Tabulator Accounting - Calculator Adding Machine Telecopier Photocopier Interline - OS & D Claims Dispatcher Chasier Rates Date MM slash DD slash YYYY Applicants Statement(Required) I have read and understand this statementI understand that WAYNE DAVISCONCRETE CO. is committed to providing equal opportunity in all employment practices, including but not limited to selection, hiring, promotion, transfer, and compensation to all qualified applicants and employees without regard to age, race, color, creed, national origin, sex, marital status, religion, handicap or disability, or any other category protect by law. In making this application for employment, I understand that the company may investigate my driving record and my criminal record and that an investigative consumer report may be made, whereby information is obtained through personal interviews with my neighbors, friends, or other with whom I am acquainted. This inquiry includes information as to my character general reputation, personal characteristics, financial responsibility, and mode of living. I understand that I have a right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigative consumer report. I authorize former and present employer, work and personal references listed in the application, and any other individuals I may name to give Wayne Davis Concrete Co. or its designee any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release such parties from all liability for any damages that may result from furnishing same to Wayne Davis Concrete Co. I understand that Wayne Davis Concrete Co. reserves the right, to the extent permitted by law, to require a drug test or post-offer medical examination as a condition of employment or at any time thereafter. I hereby give my consent to any such test or examination. I consent to the release of the results of any such test or examination to Wayne Davis Concrete. I understand that this employment application and any other company documents are not promises of employment. Should I be employed, I understand that my employment will be on trial period for 90 days the date of my hiring. I further understand that, if I am employed, I can terminate my employment with or without cause and with or without notice, at any time, and that the company has a similar right. I understand that no manager or representative of Wayne Davis Concrete Co. has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing, except that the corporate officer may do so in writing. The information given by me in this application is true and complete in all respects, and I agree that if the information is found to be false, misleading or unsatisfactory in any respect (in the exclusive judgment of the company) that I will be disqualified from consideration for employment or subject to immediate dismissal if discover after I am hired. Signature(Required)Please make sure to add your signature only if you have read the applicant statement.Upload ResumeMax. file size: 300 MB.CAPTCHA
