D.I.J. Construction, Inc.

D.I.J. Construction, Inc.

Employment Application
Name*

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Driver's License Request Form
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Date of Birth*

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License Number*
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Date of Expiration*

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Driver's License Restrictions
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Have You Been Issued a Traffic Citation in the last 7 years?*

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Please List All Traffic Citations from last 7 years
As a Driver, Have You Been Involved a Traffic Accident in the last 7 years?*

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Please List All Traffic Accidents from last 7 years
Education
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Did You Attend College?

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Reason for Leaving
Have You Ever Been Convicted of a Felony?*

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If Yes, Please Explain
Referred by:
Have You Previously Been Employed by D.I.J. Construction?*

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Dates of Previous Employment
From*

MonthDayYear
Date
To*

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Date
I HEREBY DECLARE THE ABOVE INFORMATION IS COMPLETE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I AGREE THAT IF EMPLOYED MY EMPLOYMENT IS BASED ON THE FACTS GIVEN AND ANY INTENTIONAL MISREPRESENTATION ON MY PART WILL CONSTITUTE A RELEASE TO D.I.J. CONSTRUCTION, INC. FOR ANY LIABILITY THAT THE COMPANY MAY ENCOUNTER BY HAVING ACTED ON SUCH FACTS. I UNDERSTAND THAT IF EMPLOYED, ANY FALSE STATEMENTS CONTAINED ON THIS APPLICATION CAN BE CONSIDERED CAUSE FOR DISMISSAL. I HAVE READ THE ABOVE AND UNDERSTAND IT. I HEREBY AUTHORIZE D.I.J. CONSTRUCTION, INC. TO INVESTIGATE AND VERIFY THE FACTS CLAIMED BY ME ON THIS APPLICATION.
IT IS FURTHER UNDERSTOOD THE ABOVE INFORMATION IS REQUESTED FOR THE PURPOSE OF OBTAINING A MOTOR VEHICLE REPORT FROM DEPARTMENT OF PUBLIC SAFETY AS REQUIRED BY OUR INSURANCE CARRIER.

THE REPORTED INFORMATION WILL BE USED FOR THE PURPOSE OF DETERMINING INSURABILITY AND MEETING THE REQUIRED DRIVER LICENSE CLASS AS SET FORTH IN THE JOB DESCRIPTION AND PHYSICAL DEMAND REQUIRMENTS OF THE POSITION APPLIED FOR.

BY MY SIGNATURE BELOW I ATTEST THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS AND I HERBY GIVE D.I.J. CONSTRUCTION, INC. PERMISSION TO REQUEST THE MOTOR VEHICLE REPORT.
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D.I.J. Construction, Inc.

Driver's License Request Form

Education

Employment History

Dates of Previous Employment