Date* MM slash DD slash YYYY Name* First Last Phone*Email* Address* Street Address City 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 State ZIP Code Have you been at the above residence less than 3 years?* Yes NoIf yes, list all residences for the past 3 years:StreetCityStateZip Code (Use + button to add more)Do you have the legal right to work in the United States?* Yes NoDate of Birth* MM slash DD slash YYYY Can you provide proof of age? What type?*Required for Commercial DriversIn 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 Educational Co-OpRate of pay expected:*Will you travel if job requires it?* Yes NoWill you work overtime if required?* Yes NoIf no, please explain.Who referred you?* First Last Are you currently employed?* Yes NoIf not, how long since leaving last employment?EducationHigh grade completed:* 8 9 10 11 12College: 1 2 3 4Last school attended:*List special courses or training that will help you as an employee:Summarize any special training, skills, license, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.Skills and QualificaitonsReferencesReferencesNamePhone / EmailRelationship General InformationHave you been convited of a crime in the last seven years?* Yes NoDo you have a CDL Yes NoIf yes, please explain fully:Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.Physical HistoryIs 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 HistoryThe 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 EmployerContact Person First Last Address Street Address City 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 State ZIP Code PhonePosition HeldDates of employment:WageReason for leaving:Did you drive a vehicle requiring a CDL? Yes NoPrevious EmployerContact Person First Last Address Street Address Address Line 2 City 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 State ZIP Code PhonePosition HeldDates of employment:WageReason for leaving:Did you drive a vehicle requiring a CDL? Yes NoPrevious EmployerContact Person First Last Address Street Address Address Line 2 City 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 State ZIP Code PhonePosition HeldDates of employment:WageReason for leaving:Did you drive a vehicle requiring a CDL? Yes NoDiesel Mechanic Experience QuestionaireCheck your experience level with the following vehicles.GMC None Limited ExtensiveFord None Limited ExtensiveInternational None Limited ExtensiveKenworth None Limited ExtensivePeterbilt None Limited ExtensiveMack None Limited ExtensiveOther None Limited ExtensiveDescribe your experience.Check your experience level with the following engines.Mack None Limited ExtensiveCAT None Limited ExtensiveCummins None Limited ExtensiveDetroit None Limited ExtensiveOther None Limited ExtensiveDescribe your experience.Check your experience level with the following transmissions.Mack None Limited ExtensiveSpicer None Limited ExtensiveFuller None Limited ExtensiveOther None Limited ExtensiveDescribe your experience.Check your experience level with the following rear end makes.Spicer None Limited ExtensiveEaton None Limited ExtensiveMack None Limited ExtensiveRockwell None Limited ExtensiveOther None Limited ExtensiveDescribe your experience.Check your experience level with the following areas.Clutch Adjustment None Limited ExtensiveClutch Replacement None Limited ExtensiveTransmission Replacement None Limited ExtensiveRear End Removal None Limited ExtensiveDescribe your experience.Check your experience level with the following areas.Wheel Seal Replacement None Limited ExtensiveBrake Overhaul None Limited ExtensiveAir System Repair None Limited ExtensiveAir Compressor Replacement None Limited ExtensiveDescribe your experience.Check your experience level with the following areas.Batteery Analysis None Limited ExtensiveAltenator Analysis None Limited ExtensiveElectrical Diagnosis None Limited ExtensiveWiring Harness Replacement None Limited ExtensiveDescribe your experience.Air Contitioning Service None Limited ExtensiveCheck your experience level with the following areas.Describe your experience.SignatureIt 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.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. U 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.Date* MM slash DD slash YYYY Signature*NameThis field is for validation purposes and should be left unchanged.Δ
