Employment Application (1)
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?
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Facebook
LinkedIn
Georgia Department of Labor
Job Fair
Word of Mouth
Paper Ad
Billboard
Other
Job Applying For
(Required)
Pump-Truck Driver
Name
(Required)
First
Middle
Last
Social Security No.
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Phone
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Present Address
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Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
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Algeria
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Bouvet Island
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Cook Islands
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Korea, Republic of
Kuwait
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Martinique
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Mayotte
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Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
How long have you lived there?
(Required)
Previous Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
How long did you live there?
(Required)
Date Available
(Required)
MM slash DD slash YYYY
Salary Desired
Type of employment
(Required)
Full-Time
Part-Time
If Part-Time, specify days and hour available.
(Required)
General
If Hired, can you provide proof that you are legally entitled to work in the U.S.?
(Required)
Yes
No
Have you ever worked for Taylor-Made Pumping 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 Taylor Made Pumping?
(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 Record
The 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 Employment
Name and Addres of Employer
Rate of Pay (Start to Finish)
Supervisor Name and Title
Reason for leaving
Add
Remove
Have 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)
Education
Please 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.
Name
Occupation
Address
Phone Number
Number of years known
Add
Remove
Driver Experience & Qualifications
Date 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)
Driver's Liscense No.
(Required)
Type of License Held
(Required)
State
(Required)
Physical History
The 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.
State
License No.
Type
Expiration Date
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Remove
Have 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 Equipment
Type of Equipment
Dates
Approximate Total Miles
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Remove
List 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.
Dates
Nature of accident
Fatalities
Injuries
Add
Remove
Traffic Convictions and Forfeitures for the past 3 years other than parking violations.
(Required)
If you need more spaces, please click the "plus" button.
Location
Date
Charge
Penalty
Add
Remove
Maintenance Experience & Qualifications
List any courses or training in maintenance work
(Required)
Indicate training and experience in the following:
(Required)
Body Work
Electrical Repair
Frame and Wheel Alignment
Inspections
General Car Repair
-
(Required)
Drive Line Components
Diesel Engine Tune-up and Rebuild
Tire Service
Trailer Repair
Air Conditioning
-
(Required)
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 & Qualifications
List 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
Applicants Statement
(Required)
I have read and understand this statement
I understand that Taylor-Made Pumping, INC. 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 Taylor-Made Pumping, INC. 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 Taylor-Made Pumping, INC.
I understand that Taylor-Made Pumping, INC. 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 Taylor-Made Pumping, INC.
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 Taylor-Made Pumping, INC. 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.
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