APPLICATION Date MM slash DD slash YYYY Name First Last Position Desired How were you referred to us? Address, City, State, Zip Email address Best contact phone number Full-time, Part-time, or seasonal desired Date available Do you have a valid Class A CDL and Health Card? Do you have a miners certificate? Are you CPR/First Aid Certified? Can you travel if the position requires it? Are you a U.S. Citizen? Have you ever worked at Sundre Sand & Gravel? Have you ever pled "guilty", "no contest" or been convicted of a crime? If yes, give dates & details. Have you ever been denied a license, permit or privilege to operate a motor vehicle? If yes, give dates & details. In the past 3 years have you failed or refused any DOT regulated drug or alcohol test? If yes, give dates & details. Current/Last Employer Address, Phone Position Held Dates employed at this employer Reason for leaving Previous Employer Address, Phone Position Held Dates employed at this employer Reason for leaving Next previous employer Address, Phone Position Held Dates employed at this employer Reason for leaving High School City, State DiplomaYesNoCollege City, State Course of Study DegreeYesNoReference 1 Name, Phone Number, Years known, Relationship Reference 2 Name, Phone Number, Years known, Relationship Reference 3 Name, Phone Number, Years known, Relationship Have you had any traffic convictions in the past 3 years (other than parking violations?) Please list the date, violation, location, and penalty. Have you had any accidents in the last 3 years? Please list nature of accident, fatalities, injuries, and dates. This section for DOT regulated applicants only (CDL Drivers):CDL Drivers Signature - REQUIRED IF CDL HOLDER NOTICE OF CONSUMER REPORT: PRE-ADVERSE ACTION NOTICEFull Name(Required) Date of Birth(Required) Social Security Number(Required) Drivers' License # and state(Required) Current Address(Required) Previous Address(Required) Signature of Applicant(Required)
