MDR EMPLOYMENT APPLICATION
Date
*
Position Applied For
*
Entry Level (No experience)
Entry Level (Lineman School Graduate)
Foreman
Lineman A
Lineman B
Lineman C
Operator
Groundman
Mechanic
Safety
Truck Driver
Office Administration
Other
If you selected other for position applied for please explain the position you are seeking.
*
Full Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Date Available To Work
*
E-mail
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
How long have you lived at current address?
*
SOCIAL SECURITY NUMBER (optional) :
DO YOU HAVE A COMMERCIAL DRIVER'S LICENSE (CDL) ?
*
NO
YES CLASS A PERMIT
YES CLASS A
YES CLASS B PERMIT
YES CLASS B
YES CLASS C PERMIT
YES CLASS C
YES CLASS D PERMIT
YES CLASS D
If you do not have a Class A CDL Permit, Class A CDL, or a Class B CDL your application will not be considered.
DRIVERS LICENSE NUMBER:
*
STATE ISSUED
*
DATE of EXPIRATION:
*
RESTRICTIONS:
*
To the best of your knowledge, is your drivers license valid at this time? (i.e. not under suspension)
*
Yes
NO
Have you ever been employed with us before?
*
YES
NO
If yes, what date did you leave?
If yes, give reason for leaving:
Are you currently employed?
*
Yes
No
Does your present employer know of your plans to change employment?
*
Yes
No
N/A (Not Currently Employed)
Can we contact your current or previous employer?
*
Yes
No
If no, which of your previous employers should we not contact?
Why do you desire to make a change?
*
Have you ever been discharged or asked to resign?
*
Yes
No
Do you use illegal drugs?
*
Yes
No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment.
*
Yes
No
Have you ever been convicted of a crime, pled no contest or had adjudication withheld?
*
Yes
No
If yes, explain.
Are you currently on “Lay-off” status and subject to recall?
*
Yes
No
Are you currently in the National Guard or Reserves?
Yes
No
Are you willing to travel when the job requires it?
Yes
No
The highest educational grade completed. If college or line school, list college name and level of degree.
Describe any specialized training, apprenticeship, skills and extra-curricular activities.
Previous Employment
Company Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Supervisor's Name
Your Job Title
Ending Salary
Start Date
End Date
Reason For Leaving
Company Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Supervisor's Name
Your Job Title
Start Date
End Date
Ending Salary
Reason For Leaving
Company Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Supervisor's Name
Your Job Title
Start Date
End Date
Ending Salary
Reason For Leaving
Company Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Supervisor's Name
Your Job Title
Start Date
End Date
Ending Salary
Reason For Leaving
References
Name
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position Held
Name
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position Held
Do you have family or close friends who are currently employed by MDR Construction?
Yes
NO
If so please list names of family or close friends who are currently employed by MDR Construction.
Attach Resume/Lineman School Certificate
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