GXI - Drivers Application for Employment 2026

200 Knox Rd. Tolar, TX 76476 817-579-0520

(Answer all questions – Please Print) In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or non-job related disability.

Date of Application

DayMonthYear

Position(s) Applied for

Name (Last First Middle)

First NameLast Name

Date of Birth

DayMonthYear

Social Security

Email

Cell Phone Number

Area CodePhone Number

List your addresses of residency for the past 3 years:

Current Address (Street City State Zip Code)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Previous Addresses 1 (Street City State Zip Code)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Previous Addresses 2 (Street City State Zip Code)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Experience and Qualification – Driver List all States in which you have held a driver's license in the last 3 years

Driver Licenses 1 – State

Driver Licenses 1 – License Number

Driver Licenses 1 – Type

Driver Licenses 1 – Expiration Date

DayMonthYear

Driver Licenses 2 – State

Driver Licenses 2 – License Number

Driver Licenses 2 – Type

Driver Licenses 2 – Expiration Date

DayMonthYear

Driver Licenses 3 – State

Driver Licenses 3 – License Number

Driver Licenses 3 – Type

Driver Licenses 3 – Expiration Date

DayMonthYear

Are you now employed?

If not, how long since leaving your last employment?

Is there any reason you might be unable to perform the function or the job for which you have Applied?

If yes, explain.

EMPLOYMENT HISTORY All driver applicants must provide the following information on all employers during the preceding 10 years. List complete mailing address, street number, phone numbers, fax number, City, State, and Zip Codes. Applicants to drive a commercial motor vehicle in intrastate or interstate commerce shall provide information on those employers for whom the applicant operated such vehicle. (Note: List employers in reverse order starting with the most recent. Add another sheet as necessary.)

─── Employer 1 ───

Employer 1 – NAME

Employer 1 – ADDRESS

Employer 1 – CITY

Employer 1 – STATE

Employer 1 – CONTACT PERSON

Employer 1 – PHONE #

Area CodePhone Number

Employer 1 – Fax Number

Area CodePhone Number

Employer 1 – FROM (MO/YR)

DayMonthYear

Employer 1 – TO (MO/YR)

DayMonthYear

Employer 1 – POSITION HELD

Employer 1 – SALARY/WAGE

Employer 1 – REASON FOR LEAVING

Employer 1 – WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?

Employer 1 – WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION, IN ANY DOT-REGULATED MODE SUBJECT, TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?

─── Employer 2 ───

Employer 2 – NAME

Employer 2 – ADDRESS

Employer 2 – CITY

Employer 2 – STATE

Employer 2 – CONTACT PERSON

Employer 2 – PHONE #

Area CodePhone Number

Employer 2 – Fax Number

Area CodePhone Number

Employer 2 – FROM (MO/YR)

DayMonthYear

Employer 2 – TO (MO/YR)

DayMonthYear

Employer 2 – POSITION HELD

Employer 2 – SALARY/WAGE

Employer 2 – REASON FOR LEAVING

Employer 2 – WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?

Employer 2 – WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION, IN ANY DOT-REGULATED MODE SUBJECT, TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?

─── Employer 3 ───

Employer 3 – NAME

Employer 3 – ADDRESS

Employer 3 – CITY

Employer 3 – STATE

Employer 3 – CONTACT PERSON

Employer 3 – PHONE #

Area CodePhone Number

Employer 3 – Fax Number

Area CodePhone Number

Employer 3 – FROM (MO/YR)

DayMonthYear

Employer 3 – TO (MO/YR)

DayMonthYear

Employer 3 – POSITION HELD

Employer 3 – SALARY/WAGE

Employer 3 – REASON FOR LEAVING

Employer 3 – WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?

Employer 3 – WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION, IN ANY DOT-REGULATED MODE SUBJECT, TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?

─── Employer 4 ───

Employer 4 – NAME

Employer 4 – ADDRESS

Employer 4 – CITY

Employer 4 – STATE

Employer 4 – CONTACT PERSON

Employer 4 – PHONE #

Area CodePhone Number

Employer 4 – Fax Number

Area CodePhone Number

Employer 4 – FROM (MO/YR)

DayMonthYear

Employer 4 – TO (MO/YR)

DayMonthYear

Employer 4 – POSITION HELD

Employer 4 – SALARY/WAGE

Employer 4 – REASON FOR LEAVING

Employer 4 – WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?

Employer 4 – WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION, IN ANY DOT-REGULATED MODE SUBJECT, TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?

─── Employer 5 ───

Employer 5 – NAME

Employer 5 – ADDRESS

Employer 5 – CITY

Employer 5 – STATE

Employer 5 – CONTACT PERSON

Employer 5 – PHONE #

Area CodePhone Number

Employer 5 – Fax Number

Area CodePhone Number

Employer 5 – FROM (MO/YR)

DayMonthYear

Employer 5 – TO (MO/YR)

DayMonthYear

Employer 5 – POSITION HELD

Employer 5 – SALARY/WAGE

Employer 5 – REASON FOR LEAVING

Employer 5 – WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?

Employer 5 – WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION, IN ANY DOT-REGULATED MODE SUBJECT, TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?

─── Employer 6 ───

Employer 6 – NAME

Employer 6 – ADDRESS

Employer 6 – CITY

Employer 6 – STATE

Employer 6 – CONTACT PERSON

Employer 6 – PHONE #

Area CodePhone Number

Employer 6 – Fax Number

Area CodePhone Number

Employer 6 – FROM (MO/YR)

DayMonthYear

Employer 6 – TO (MO/YR)

DayMonthYear

Employer 6 – POSITION HELD

Employer 6 – SALARY/WAGE

Employer 6 – REASON FOR LEAVING

Employer 6 – WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?

Employer 6 – WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION, IN ANY DOT-REGULATED MODE SUBJECT, TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?

Have you previously applied to, or worked for Granbury Excavation, Inc.?

If so, when?

Are you related in any way to a current GXI employee?

If yes, to who and what is the relation?

Accident Record for the Past 3 Years (If there are no accidents to report, indicate with "N/A" or "None")

Last Accident – Date

DayMonthYear

Last Accident – Nature (Roll over, Rear End, etc.)

Last Accident – Fatalities

Last Accident – Injuries

Next Previous Accident – Date

DayMonthYear

Next Previous Accident – Nature (Roll over, Rear End, etc.)

Next Previous Accident – Fatalities

Next Previous Accident – Injuries

Driving Experience

Driving Experience – Straight Truck – Class of Equipment

Driving Experience – Straight Truck – Type of Equipment

Driving Experience – Straight Truck – Dates: From / To

Driving Experience – Straight Truck – Miles Driven

Driving Experience – Tractor Semi-Trailer – Class of Equipment

Driving Experience – Tractor Semi-Trailer – Type of Equipment

Driving Experience – Tractor Semi-Trailer – Dates: From / To

Driving Experience – Tractor Semi-Trailer – Miles Driven

Driving Experience – Tractor 2 Trailer Combo – Class of Equipment

Driving Experience – Tractor 2 Trailer Combo – Type of Equipment

Driving Experience – Tractor 2 Trailer Combo – Dates: From / To

Driving Experience – Tractor 2 Trailer Combo – Miles Driven

Driving Experience – Other – Class of Equipment

Driving Experience – Other – Type of Equipment

Driving Experience – Other – Dates: From / To

Driving Experience – Other – Miles Driven

List All Traffic Fines and Forfeitures for the Past 3 Years (If there is nothing to report, indicate with "N/A" or "None")

Traffic Violation 1 – Location

Traffic Violation 1 – Date

DayMonthYear

Traffic Violation 1 – Charge

Traffic Violation 1 – Penalty

Traffic Violation 2 – Location

Traffic Violation 2 – Date

DayMonthYear

Traffic Violation 2 – Charge

Traffic Violation 2 – Penalty

Traffic Violation 3 – Location

Traffic Violation 3 – Date

DayMonthYear

Traffic Violation 3 – Charge

Traffic Violation 3 – Penalty

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle

B. Has any license you held ever been suspended or revoked?

If you answered yes to any of the above give details below.

C. Have you ever tested positive, or refused to test, on any pre-employment drug test Administered by an employer to which you applied for, but did not obtain, safety Sensitive transportation work covered by DOT agency drug testing rules during The past two years?

D. If you answered yes can you provide/ obtain proof that you've successfully completed The DOT return-to-duty requirements?

E. Have you ever been convicted of a felony?

If you answered "yes" to A, B, or E above, provide a detailed explanation below:

Granbury Excavating, Inc. TO BE READ AND SIGNED BY THE APPLICANT

I authorize you to make such investigations and inquiries of my personal background, employment history, medical history, driving record, academic/professional credentials, military service, and other related matters as may be necessary in arriving at an employment decision and as necessary throughout the course of my employment. (Generally, inquiries regarding medical history will be made only after a conditional offer of employment has been extended.) I hereby release former employers, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application for employment. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate discharge. I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance, work performance, safety performance, and reasons for separation as required by 49 CFR 391.23(d) and (e). I understand I have the right to: • Review information provided by previous employers; • Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information. I am aware any offer of employment will be contingent upon satisfactory completion of a pre-employment drug screen and physical evaluation. The employment offer may be withdrawn if the result of either is unsatisfactory. If you wish to review previous employer-provided investigative information, you must submit a written request to the Company, no later than 30 days after being employed or being notified of denial of employment. The Company will provide the requested investigative information to you within five (5) business days of receiving this written request, or five (5) business days of receipt of the requested information from the previous employer, whichever is later. This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

Date

DayMonthYear

Applicant's Signature

IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP ONLINE SERVICE

In connection with your application for employment with Granbury Excavating, Inc., 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.fmcsa.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 DataQs 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 Granbury Excavating, Inc. 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 (3) 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 FMCSA 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 DataQs 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, 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 received a copy of the FMCSA Pre-Employment Screening Program 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.

Date

DayMonthYear

Printed Name

Signature

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Granbury Excavating, Inc. DRIVERS APPLICATION FOR EMPLOYMENT