You are applying for: not specified If this isn’t the job you meant to select go back to the careers page and try again. Employment Application - CDL SEMA Construction, Inc. Pre-Employment Application An Equal Opportunity Employer SEMA Construction, Inc. participates in the E-Verify Program. If this is not for an advertised position, this application will be kept on file for only 60 days. The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex or national origin. Various other laws and regulations prohibit discrimination in employment because of handicap, age, disabled veterans, Vietnam Era veteran status, creed, marital status, or statue with regard to public assistance. SEMA Construction, Inc. is an Equal Opportunity Employer. Step 1 of 2 50% Position You Are Applying For (Old dropdown)N/APosition You Are Applying ForDateReferred By*PersonalName* First Last MIMISocial Security Number*Date of Birth*Can you provide proof of age?*YesNoPresent Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How Long?*Cell Phone*Home Phone*Email* Are you legally authorized to work in the United States?*YesNoHave you worked for us before?*YesNoFromDate you began working for usToDate you stopped working for usWhere?*Rate of Pay*Position*Reason for Leaving*Who was your supervisor?Are you now employed?*YesNoIf not, how long since last employment?Rate of pay expected*Have you ever been bonded?*YesNoName of bonding companyIs 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)?*YesNoIf yes, explain if you wishIf Hired, when would you be available to start work?*If asked, will you be willing to work overtime?*YesNoIf asked, will you be willing to travel?*YesNoHave you ever been convicted of any law violation? (Include any plea of “guilty” or “no contest.” Exclude minor traffic violations.)*YesNoIf 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 NameSubjects StudiedDid you graduate?Years Attended U S Military ServiceDate of SeparationDrivers License NumberClassState IssuedExpiration Date Date Format: MM slash DD slash YYYY Commercial Drivers License NumberClassState IssuedExpiration Date Date Format: MM slash DD slash YYYY Have you had your driver’s license suspended or revoked in the last 3 years?*YesNoIf yes, give detailsReferences: Give three references, not relatives.*NameAddressPhone Employment HistoryAll 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?*YesNoIf yes, may we contact your current employer?*YesNoEmployment History Employer Name Actions Edit Delete There are no Previous Employers. Add Previous Employer Maximum number of previous employers reached. 1Company Name*Phone*Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Job Title*Dates Employed*FromTo List Wage*Name of Supervisor*Supervisor's TitlePhone*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?*YesNoWas 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?*YesNoAccident RecordDate of AccidentNature of Accident (Head-on, Rear-end, etc)FatalitiesInjuriesHazardous Material Spill Traffic ConvictionsLocationDateChargePenalty Experience and QualificationsStateLicense No.ClassEndorsement(s)Expiration Date Drivers Licenses or permits held in the past 3 yearsHave you ever been denied a license, permit, or privilege to operate a motor vehicle?*YesNoIf yes, please explain*Has any license, permit, or privilege ever been suspended or revoked?*YesNoIf yes, please explain*Driving ExperienceStraight Truck*YesNoType of EquipmentVan, Tank, Flat, Dump, ReferDatesFromTo Approximate number of milesTractor and Semi-Trailer*YesNoType of EquipmentVan, Tank, Flat, Dump, ReferDatesFromTo Approximate number of milesTractor - Two Trailers*YesNoType of EquipmentVan, Tank, Flat, Dump, ReferDatesFromTo Approximate number of milesTractor - Three Trailers*YesNoType of EquipmentVan, Tank, Flat, Dump, ReferDatesFromTo Approximate number of milesMotorcoach - School Bus - More than 8 passengers*YesNoDatesFromTo Approximate number of milesMotorcoach - School Bus - More than 15 passengers*YesNoDatesFromTo Approximate number of milesOtherList 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 - OtherShow 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)*EducationSelect highest grade completed*123456789101112College*1234Person to call in case we cannot contact youName*Relationship*Phone*AFFIDAVIT, CONSENT and RELEASEPlease 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* Date Format: MM slash DD slash YYYY Resume Upload (optional)Accepted file types: doc, docx, pages, odt, rtf, tex, txt, wpd, wps, pdf.If you have a resume you'd like to attach, please do so here. FORM 2510Affirmative Action Survey It is the policy of SEMA Construction, Inc. (SEMA) to provide equal employment opportunities to all qualified applicants for employment without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, veteran status or disability. As an affirmative action employer under E.O. 11246, we invite all applicants to identify themselves as indicated below. The information collected is used for compliance with government regulations and record keeping guidelines. COMPLETION OF THIS FORM IS VOLUNTARY AND IN NO WAY AFFECTS THE DECISION REGARDING YOUR APPLICATION FOR EMPLOYMENT. THIS FORM IS CONFIDENTIAL AND WILL BE MAINTAINED SEPARATELY FROM YOUR APPLICATION FORM.Date* Date Format: MM slash DD slash YYYY Name (Last, First, Middle)* Position Applied For*Where did you hear about this position?*IndeedEmployment AgencyEmployee ReferralWebsiteWalk-inOnline AdNewspaper AdRehireCraigslistBuild ColoradoNat'l Association of Women in ContructionRacial Origin/Ethnicity (You may mark one or more of the following): Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam. American Indian or Alaska Native – A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment. Black or African American – A person having origins in any of the black racial groups of Africa. Caucasian – A person having origins in any of the original peoples of Europe, the Middle East or North Africa. Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race. Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands. Other If other, please specifyGenderMaleFemaleService Status: Are you a veteran?YesNoCheck all that apply Vietnam Era Veteran Disabled Veteran Disabled Individual I elect not to identify