Highway Improvement, Inc. Job Application
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Sex
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Emergency Contact
*
Ethnic Origin
*
Social Security Number
*
Please upload an image of your Social Security Card.
*
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Marital Status
*
Married
Single
Are you able to travel?
*
Yes
No
Do you have any problem being gone 2 to 3 weeks?
Yes
No
Are you presently working?
*
Yes
No
Where
*
How Long?
*
Do you have any physical limitations?
*
Yes
No
What?
*
Have you ever injured your back?
*
Yes
No
Explain:
*
Are you a citizen of the United States?
*
Yes
No
Are you authorized to work in the U.S.
*
Yes
No
Do you have a valid driver's license?
*
Yes
No
Drivers License State
*
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
Drivers License Number
*
Please upload an image of your drivers license
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Do you have a CDL?
*
Yes
No
Would you be willing to apply for one?
*
Yes
No
Have you ever worked for this company?
*
Yes
No
When did you work for us?
*
Have you ever been convicted of a D.U.I. ?
*
Yes
No
When was your D.U.I.?
*
Did you lose your license?
*
Yes
No
Have you had any traffic violations in the past 3 years?
*
Yes
No
Please provide traffic violation details.
*
Have you ever been convicted of a felony?
*
Yes
No
Please provide felony details.
*
Education Completed
*
Please Select
High School - Grade 8
High School - Grade 9
High School - Grade 10
High School - Grade 11
High School - Grade 12
College - 1 year
College - 2 years
College - 3 years
College - 4 years
Trade School
*
Trade School Phone
*
References
*
Rows
Name
Address
Phone
Employment History
*
Rows
Company
Position
Contact
Phone
Why should we hire you?
*
I certify that the answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature
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