K&W Underground, Inc. Application for Employment

Application for Employment

General Information
Full Name*

First Name Middle Name Last Name
Phone Number*

Area Code Phone Number
Current Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Date of Birth*
Social Security Number*
Email Address*
Today's Date/Date of Application*

MonthDay Year
Date
Date Available to Start Work

MonthDay Year
Date
Type of Employment Desired*
Are you able to meet the attendance requirements?*
Are you able to work overtime?*
Are you able to travel if required by this position?*
Have you worked at K&W Underground, Inc. previously*
Are you legal to work in the United States?*
If under 18, can you furnish a work permit?*
Have you ever been convicted of a crime in the past 7 years?*
If yes, please explain: (a conviction does not automatically bar employment)
How did you hear about K&W Underground, Inc.? (ex: Web Search, Facebook, Indeed, friend) *
Previous Address(es) for past three years:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Length:
Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Length:
Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Length:
Employment History *Please provide employment information for your past TEN years of starting with the most recent.*
Employer's Name:*
Position Held:*
Address:*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Supervisor Name & Title:*
Phone Number:*

Area Code Phone Number
Fax:

Area Code Phone Number
Email Address:
example@example.com
Starting Date of Employment:*

MonthDay Year
Date
Ending Date of Employment:*

MonthDay Year
Date
Salary/ Pay Rate:
Job Summary:*
Were you subject to Federal Motor Carrier Safety Regulations (FMCSRs) while employed by this employer?*
Was this position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and control substance testing requirements?*
Reason for Leaving:*
Employer's Name:
Position Held:
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Supervisor Name & Title:
Phone Number:

Area Code Phone Number
Fax:

Area Code Phone Number
Email Address:
example@example.com
Starting Date of Employment:

MonthDay Year
Date
Ending Date of Employment:

MonthDay Year
Date
Salary/ Pay Rate:
Job Summary:
Were you subject to Federal Motor Carrier Safety Regulations (FMCSRs) while employed by this employer?
Was this position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and control substance testing requirements?
Reason for Leaving:
Employer's Name:
Position Held:
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Supervisor Name & Title:
Phone Number:

Area Code Phone Number
Fax:

Area Code Phone Number
Email Address:
example@example.com
Starting Date of Employment:

MonthDay Year
Date
Ending Date of Employment:

MonthDay Year
Date
Salary/ Pay Rate:
Job Summary:
Were you subject to Federal Motor Carrier Safety Regulations (FMCSRs) while employed by this employer?
Was this position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and control substance testing requirements?
Reason for Leaving:
Educational History
High School:*
Did you graduate?*
College:
Did you graduate?
Technical Training:
Did you graduate?
Skills and Qualifications
Please list any job related training, skills, licenses and certificates:*
Driver Experience and Qualifications: Section 383.21 FMCSR states "No person who operates a commercial motor vehicle at any time may have more than one driver's license". I certify that I do not have more than one motor vehicle license, the information for which is listed below.

	State	Type	License Number	Expiration Date
Driver Licenses
Driver Licenses

	Type of Equipment (Van, tank, flat, etc.)	Date From	Date To	Approximate number of miles total
Straight Truck
Tractor and Semi- Trailer
Tractor- Two Trailers
Other

Have you ever been denied a license, permit or priviledge to operate a motor vehicle?*
Has any license, permit or priviledge ever been suspended or revoked?*
If you answered yes to either questions above, please give a statement explaining details.
Traffic Convictions and Forfeitures for Past 3 Years (excluding parking violations):
Location
Date

MonthDay Year
Date
Charge
Penalty
Location
Date

MonthDay Year
Date
Charge
Penalty
Location
Date

MonthDay Year
Date
Charge
Penalty
Location
Date

MonthDay Year
Date
Charge
Penalty
Accident Record for Past 3 Years:
Date

MonthDay Year
Date
Nature of Accident
(head on, rear end, upset, etc.)
Fatalities
Injuries
Date

MonthDay Year
Date
Nature of Accident
(head on, rear end, upset, etc.)
Fatalities
Injuries
Date

MonthDay Year
Date
Nature of Accident
(head on, rear end, upset, etc.)
Fatalities
Injuries
Commercial Driving Experience: In addition to your past three employers, the Department of Transportation requires that you list at least 10 years of Commercial Driving Experience (if applicable). Please use the text box or upload a resume below to list all commercial driving employers.
Upload Resume
Commercial Driving Experience/ Employers:
References: Please list three reference- name, phone numbers, and years known. Please do not include relatives or employers.
References:*
Emergency Contact:
Name*

First Name Last Name
Phone Number*

Area Code Phone Number
Email
example@example.com
I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions and references. I also hereby release from liability the potential employer and it's representatives for seeking, gathering and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment, if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person's need for a reasonable accommodation as required by the ADA.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

I represent and warrant that I have read and fully understand the foregoing and that I seek employment under these conditions.

By signing, I certify that this application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge.
E- Signature

Clear
K&W Underground, Inc. is an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state or federal law. Equal access to employment, service and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the organization.

Property of K&W Underground, Inc.
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