Bama Concrete Employment Application

Employment Application

Please complete the form below to apply for a position with us.
Location Preferred*
Position Applied For*
Full Name*

First NameMiddle NameLast Name
Date of Birth:*

MonthDayYear
Date
Social Security Number*
Do Not Include Dash
Phone Number*
Current Address*

Street Address

Street Address Line 2

CityState

Zip Code
Previous Address

Street Address

Street Address Line 2

CityState

Zip Code
How long At Current Address?*
Drivers License Number*
State of Issue*
Drivers License Photo
Drivers License File if needed

Cancelof
Emergency Contact Info*

Name

Relationship

CityState / Province

Phone Number

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state, and zip code. NOTE: List employers in reverse order, starting with the most recent.
*
Business Name* Street Address City State Zip Position Held* Date from* Date to* Contact PersonReason For Leaving Phone Number of Business
Business Name Street Address City State Zip Position Held Date From Date to Contact Person Reason For Leaving Phone Number of Business
Business Name Street Address City State Zip Position Held Date From Date toContact Person Reason For Leaving Phone Number of Business
Business Name Street Address City State Zip Position Held Date From Date To Contact Person Reason For Leaving Phone Number of Business

Motor Vehicle Report Request Form
My Name is,   First Name*   Last Name*
I am either an employee or a perspective employee of Bama Concrete Products, Inc. / Davis Sand and Gravel / or Davis Hauling LLC.
My Date of Birth Is:   Date*
My Drivers License Number is:  Number*
In the State of:   *
My Social Security Number Is   Number*
I have had my CDL for     Number*   Years.

I hereby authorize Bama Concrete Products / Davis Sand and Gravel / or Davis Hauling LLC to obtain my Motor Vehicle Report. I understand that insurance companies use the Motor Vehicle Report to determine whether or not a driver is suitable to operate a company-issued vehicle. By signing this letter, i hereby authorize Bama Concrete Products/ Davis Sand and Gravel / or Davis Hauling LLC to obtain this Motor Vehicle Report and Share the information with the insurance company.
Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
Date

DRUG & ALCOHOL CLEARINGHOUSE CONSENT FOR LIMITED QUERIES

NOTICE TO DRIVER: The Commercial Driver’s License (CDL) Drug & Alcohol Clearing house is a federal database containing information about CDL drivers who have violated the Federal Motor Carrier Safety Administration’s (FMCSA’s) drug or alcohol regulations in 49 CFR Part382. Whether you have committed such a violation or not, each motor carrier for whom you drive is required to check whether the Clearinghouse has any information about you, both at the time of hire and annually. When conducting an annual inquiry, the motor carrier has the option to request a “limited” report that only indicates whether the Clearinghouse has any information about you. Before a motor carrier may request a limited report, they must have your written authorization, per §382.701(b). This authorization may be valid for more than one year. If a limited query ever reveals that the Clearinghouse has information about you, you will be required to log in to the Clearinghouse website within 24 hours to grant electronic consent for the motor carrier to obtain your full Clearinghouse record. NOTICE TO MOTOR CARRIER: This consent form authorizes you to run a “limited query” to check whether the Clearinghouse has information about the driver identified below. If it does, then you must obtain a full Clearinghouse record within 24 hours, per §382.701(b). This consent form must be retained until 3 years after the date of the last limited query you perform for this driver, based on the authorization below.
I First Name* Last Name* Hereby Authorize
Bama Concrete Davis Sand and Gravel 2 Davis Hauling 3*
to conduct limited annual queries of the FMCSA’s Drug & Alcohol Clearinghouse, to determine if a Clearinghouse record exists for me. This consent is valid from the date shown below until my employment with the above-named motor carrier ceases or until I am no longer subject to the drug and alcohol testing rules in 49 CFR Part 382 for the above-named motor carrier. I understand that if any limited query reveals that the Clearinghouse contains information about me, I must grant electronic consent within 24 hours, via the Clearinghouse website, for the motor carrier to obtain my full Clearinghouse record. Refusal to provide such consent will result in my removal from
safety-sensitive duties.

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with Bama Concrete Products, or Davis Sand and Gravel and/or Davis Hauling LLC. its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA).When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act. Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.frncsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the Data Qs system to the appropriate State for adjudication. Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report. The Prospective Employer cannot obtain background reports from FMCSA without your authorization.
Authorization

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: I authorize Bama Concrete Products, or Davis Sand and Gravel, and/or Davis Hauling LLC to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee. I further understand that neither the Prospective Employer nor the FMC SA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If i challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the Data Qs system to the appropriate State for adjudication. I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report. I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.
Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
Date

Please rate you application experience.

Thank you!
Should be Empty:

Employment Application

Additional Information

Employment History

Motor Vehicle Report Request Form

DRUG & ALCOHOL CLEARINGHOUSE CONSENT FOR LIMITED QUERIES

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

Authorization