Apply - CDL Jobs - SEMA Construction

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Position You Are Applying For

Date

Referred By*

Personal

Name*

First Last

MI

Social Security Number*

Date of Birth*

Can you provide proof of age?*

Yes
No

Present Address*

Street Address City State ZIP Code

How Long?*

Cell Phone*

Home Phone*

Email*

Are you legally authorized to work in the United States?*

Yes
No

Have you worked for us before?*

Yes
No

From

Date you began working for us

To

Date you stopped working for us

Where?*

Rate of Pay*

Position*

Reason for Leaving*

Who was your supervisor?

Are you now employed?*

Yes
No

If not, how long since last employment?

Rate of pay expected*

Have you ever been bonded?*

Yes
No

Name of bonding company

Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)?*

Yes
No

If yes, explain if you wish

If Hired, when would you be available to start work?*

If asked, will you be willing to work overtime?*

Yes
No

If asked, will you be willing to travel?*

Yes
No

Have you ever been convicted of any law violation? (Include any plea of “guilty” or “no contest.” Exclude minor traffic violations.)*

Yes
No

If yes, give details*

A conviction will not necessarily disqualify an applicant for employment.

Name and Location of School? (Click the + button to add a new row)*

School Name	Subjects Studied	Did you graduate?	Years Attended

U S Military Service

Date of Separation

Drivers License Number

Class

State Issued

Expiration Date

Commercial Drivers License Number

Class

State Issued

Expiration Date

Have you had your driver’s license suspended or revoked in the last 3 years?*

Yes
No

If yes, give details

References: Give three references, not relatives.*

Name	Address	Phone

Employment History

All driver applicants to drive in interstate commerce must provide the following information an all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code. Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years’ 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.)

Are you currently working?*

Yes
No

If yes, may we contact your current employer?*

Yes
No

Employment History

Employer Name
	Edit Delete
There are no Previous Employers.

1

Company Name*

Phone*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title*

Dates Employed*

From	To

List

Wage*

Name of Supervisor*

Supervisor's Title

Phone*

What did you like most about the job?*

What did you like least?*

Duties*

Reasons for Leaving*

Were you subject to the FMCSRs while employed?*

Yes
No

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?*

Yes
No

Accident Record

Date of Accident	Nature of Accident (Head-on, Rear-end, etc)	Fatalities	Injuries	Hazardous Material Spill

Traffic Convictions

Location	Date	Charge	Penalty

Experience and Qualifications

State	License No.	Class	Endorsement(s)	Expiration Date

Drivers Licenses or permits held in the past 3 years

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?*

Yes
No

If yes, please explain*

Has any license, permit, or privilege ever been suspended or revoked?*

Yes
No

If yes, please explain*

Driving Experience

Straight Truck*

Yes
No

Type of Equipment

Van, Tank, Flat, Dump, Refer

Dates

From	To

Approximate number of miles

Tractor and Semi-Trailer*

Yes
No

Type of Equipment

Van, Tank, Flat, Dump, Refer

Dates

From	To

Approximate number of miles

Tractor - Two Trailers*

Yes
No

Type of Equipment

Van, Tank, Flat, Dump, Refer

Dates

From	To

Approximate number of miles

Tractor - Three Trailers*

Yes
No

Type of Equipment

Van, Tank, Flat, Dump, Refer

Dates

From	To

Approximate number of miles

Motorcoach - School Bus - More than 8 passengers*

Yes
No

Dates

From	To

Approximate number of miles

Motorcoach - School Bus - More than 15 passengers*

Yes
No

Dates

From	To

Approximate number of miles

Other

List states operated in for last five years*

Show special courses or training that will help you as a driver*

Which safe driving awards do you hold and from whom?*

Experience and Qualifications - Other

Show any trucking, transportation, or other experience that may help in your work for this company*

List courses and training other than shown elsewhere in this application*

List special equipment or technical materials you can work with (other than those already shown)*

Education

Select highest grade completed*

College*

Person to call in case we cannot contact you

Name*

Relationship*

Phone*

AFFIDAVIT, CONSENT and RELEASE

Please read each statement carefully before signing.

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers, and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I understand I will be required to successfully pass a Drug Screening Examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment. I understand SEMA may also perform a Background Check which could include checking references, past employment, education/training history, criminal history, and/or credit history. Post-hire, SEMA may additionally obtain a Workers Compensation History to assure the employee is assigned duties with in restrictions.

I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete Pre-Employment Physical Examination (Fit for Duty). I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.

I understand that this application, verbal statements by management, or subsequent employment does not create an express or implied contract of employment nor guarantee employment for any definite period of time. Only the Corporate President/CEO of SEMA has the authority to enter into an agreement of employment for any specified period and such agreement must be in writing, signed by the Corporate President/CEO and the employee. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without reason and with or without notice.

I understand that I may be terminated if I have falsified any information on this application. I have read, understand, and by my signature consent to these statements.

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

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 history as required by 49 CFR 391.23(d) and (e). I understand that 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.

Signature*

Date*

Resume Upload (optional)

If you have a resume you'd like to attach, please do so here.

Apply – CDL Jobs

Employment Application - CDL

Step 1 of 2

Personal

Employment History

1

Driving Experience

Experience and Qualifications - Other

Education

Person to call in case we cannot contact you

AFFIDAVIT, CONSENT and RELEASE

FORM 2510