2024 RDR Utility Services Group - Employment Application

Job Application
Name*

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Date

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Date
Current Address*

Street Address

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CityState / Province

Postal / Zip Code
How long?
Permanent Address(if different)

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Postal / Zip Code
How long?
Home phone number
Please enter a valid phone number.
Cell phone number*
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Email Address*
example@example.com
Social security number
Birth Date

MonthDayYear
ADDRESSES OF RESIDENCES FOR THREE PRIOR YEARS (if at current address less than three years)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long?
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long?
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long?
Position Applying For
How did you hear about us?
Referred by:
How did you hear about us?

AdvertisementEmployment AgencyRelativeWebsiteOther
Is there any information we would need about your name or use of another name for us to be able to check your background and work record?If so, please explain and list any other name(s) used (including maiden name) if applicable:
Do any of your friends, relatives or a current/former spouse, work at RDR Energy?

YesNo
If yes, state name and relationship:
Are You over 18 years old?

YesNo
Are you a citizen of the United States?

YesNo
Are you authorized to work in the United States?

YesNo
Will you now or in the future require sponsorship for employment visa status (e.g. H–1B visa status)?

YesNo
Have you worked at RDR before?*

YesNo
If so, When? Position:
Have you been told the essential functions of this job, or have you been shown a copy of the job description listing the essential functions of the job?

YesNo
Have you ever been convicted of, pled “guilty” or “no contest” to a felony or a misdemeanor crime and/or have you ever been subject to deferred adjudication? Please note: This includes felony and/or misdemeanor DUI’s. (Conviction will not necessarily disqualify applicant from eligibility for employment.)

YesNo
If yes, please explain:
Employment History
Current/most recent employer*
Were you subject to the Federal Motor Carrier Safety Regulations while employed by this employer?

YesNo
Did you perform any safety sensitive functions in this job, regulated by DOT and subject to drug and alcohol testing requirements as required by Federal Regulations 49 CFR part 40?

YesNo
Previous employer
Were you subject to the Federal Motor Carrier Safety Regulations while employed by this employer?

YesNo
Did you perform any safety sensitive functions in this job, regulated by DOT and subject to drug and alcohol testing requirements as required by Federal Regulations 49 CFR part 40?

YesNo
Previous employer
Were you subject to the Federal Motor Carrier Safety Regulations while employed by this employer?

YesNo
Did you perform any safety sensitive functions in this job, regulated by DOT and subject to drug and alcohol testing requirements as required by Federal Regulations 49 CFR part 40?

YesNo
References
Work Availability
If your application receives favorable consideration, when would you be available to begin work?
Do you have any objection to working overtime?

YesNo
Can you work on a Saturday or a Sunday if your department’s workload requires it?

YesNo
Are you available to travel if it is required by this position?

YesNo
Salary / Hourly Rate Requirements
If your application receives favorable consideration, what salary / hourly rate would you require?

$ per
Qualifications and Experience
QUALIFICATIONS

DRIVING EXPERIENCE

	Equipment class(Check If operated)	Type of equipment(Van, Pole, Flat, etc.)	Dates To: From:	Approximate number of milesoperated
Straight truck
Tractor-trailer
Crane
Other

ACCIDENT RECORD FOR PREVIOUS THREE (3) YEARS

	Type of accident(Head-on, roll-over, etc)	Fatalities involved	Injuries involved
Last accident:
Previous:
Previous:
Previous:

Review of Driving Record
DRIVER RECORD REQUEST

Each motor carrier shall make an investigation of each driver’s driving record during the preceding three (3) years to the appropriate agency of every statein which the driver held a motor vehicle operator’s license or permit during those three (3) years. The motor carrier is required to make this investigationwith respect to each driver it employs or wishes the employ. The inquiry to state agencies must be made within thirty (30) days of the date the driver’semployment begins and shall be made in the form and manner those agencies prescribe. A copy of the response by each state be showing the driver’sdriving record of certifying that no driving record exists for the driver, shall be retained in the carrier’s files as part of the diver’s qualification file.
I, name the above referenced driver, certify that I have read the requirements set forth in the Federal Motor Carrier Safety
Regulations regarding the inquiry into my past driving record. I understand that such inquiry is necessary on the part of RDR Energy Resources. I
hereby release any and all agencies involved in the act of obtaining my driving record from any and all liability which could result from
furnishing such information. I understand that a firm retained by RDR Energy Resources may actually request my driving record from a state for the benefit
of RDR Energy Resources and I further release any such company or firm from any and all liability which could result from obtaining such information.
Drivers signature*

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Disclaimer
In consideration of my employment, I agree to conform to the rules and regulations of this facility. I understand that my employment can be terminated at any time and for any reason, at the option of either the facility or myself. I understand that no one 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 for a written employment agreement signed by an administrative representative of this facility. I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete. I understand that any false or misleading representations or omissions may disqualify me from further consideration of employment and will result in discharge even if discovered at a later date. I also understand any offer of employment is conditioned upon results of post-offer medical examination which includes a drug screening. I hereby authorize persons, schools, my current employer (if applicable) and previous employers and organizations named in this application (and accompanying resume, if any, to provide this facility and all affiliates with any relevant information regarding an employment decision, and I release all such persons from any liability regarding the provision or use of such information. RDR Utility Services Group is an equal opportunity employer. No person shall be discriminated against on account of race, color, religious creed, national origin, ancestry, sex, disability or status as a veteran or any other unlawful basis.

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Job Application

Employment History

References

Work Availability

Salary / Hourly Rate Requirements

Qualifications and Experience

Review of Driving Record

Disclaimer