background

Employment Application

Signature of Applicant*

Date*

Your Name*

Your Email*

Your Full Address (including city and state)*

Phone Number*

Position(s) applied for*

Salary Requirements*

Hours available*

Date available for work*

Are you at least 18 yrs old?
YesNo

Were you previously employed by us?
YesNo

If yes, when?

Have you ever been convicted of a felony/misdemeanor?
YesNo

If yes, please explain?

Are there any circumstances that could prevent you from being at work on our regular work hours?
YesNo

How did you happen to apply at Crooker Construction, LLC?

Were you referred by a current Crooker Construction or Precast of Maine employee?
YesNo

If yes, who?


Education: List all schools attended.

Name & Address of School
High/Prep

Graduate?
YesNo

Name & Address of School
College

Graduate?
YesNo

Degree

Curriculum/Major


Special Skills: Please list special skills/abilities (i.e., equipment or mechanical experience, licenses, software familiarity, etc.)


Employment History: List employment history beginning with your two most recent positions.

Employer #1

Present/Most Recent Employer

Phone

Address

May we contact this employer?
YesNo

Supervisor

Nature of business

Starting Date

Ending Date

Starting Salary

Ending Salary

Title(s) and Description of Duties

Reason(s) for leaving

Which duties would you have preferred to have done more of?

Which duties would you have preferred to have done less of?

Employer #2

Previous Employer

Phone

Address

May we contact this employer?
YesNo

Supervisor

Nature of business

Starting Date

Ending Date

Starting Salary

Ending Salary

Title(s) and Description of Duties

Reason(s) for leaving

Which duties would you have preferred to have done more of?

Which duties would you have preferred to have done less of?

Employer #3

Previous Employer

Phone

Address

May we contact this employer?
YesNo

Supervisor

Nature of business

Starting Date

Ending Date

Starting Salary

Ending Salary

Title(s) and Description of Duties

Reason(s) for leaving

Which duties would you have preferred to have done more of?

Which duties would you have preferred to have done less of?


Driver's License Information

Do you have a valid driver's license?
YesNo

Driver's License State:

Driver's License Number:

Addresses where applicant resided 3 years preceding application date:

#1: Street, City, State, Zip

#2: Street, City, State, Zip

#3: Street, City, State, Zip


Please complete if you have a commercial Driver's License (CDL)

Information for Driver's Licenses Held In The Past 3 Years

#1

State:

License Number:

Class:

Endorsement(s):

Expiration Date:

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

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

Have you ever been disqualified for violations of Federal Motor Carrier Safety Regulations?
YesNo
If you answered "yes" to any of the above questions, please explain in the Additional Notes section at the bottom of this form.

Driving Experience

Straight Truck

Type of Equipment (Van/Tank/Flat/Dump)

Dates (from & to)

Approximate Total Miles

Tractor and Semi Trailer

Type of Equipment (Van/Tank/Flat/Dump)

Dates (from & to)

Approximate Total Miles

Other

Type of Equipment (Van/Tank/Flat/Dump)

Dates (from & to)

Approximate Total Miles

Accident Review for the Past 3 Years

#1

Date

Nature of Accident (Head-On/Rear-End/Overturn, etc)

Fatalities

Injuries

Additional Notes

#2

Date

Nature of Accident (Head-On/Rear-End/Overturn, etc)

Fatalities

Injuries

If there are any additional accidents to report, please include them in the Additional Notes section at the bottom of this form.

Traffic Convictions and Forfeitures for the past 3 years

do not include parking violations

#1

Location

Date

Charge

Penalty

#2

Location

Date

Charge

Penalty

If there are any additional traffic convictions to report, please include them in the Additional Notes section at the bottom of this form.


Applicant's Name

Date

CROOKER CONSTRUCTION, LLC IS A FEDERAL GOVERNMENT CONTRACTOR/SUBCONTRACTOR AND IS REQUIRED TO REQUEST THE FOLLOWING INFORMATION FOR AFFIRMATIVE ACTION PURPOSES ONLY.

Sex
MaleFemale

Race
American Indian or Alaskan NativeBlack, Not of Hispanic OriginAsian or Pacific IslanderHispanicWhite, Not of Hispanic Origin

PROVIDING THIS INFORMATION IS PURELY VOLUNTARY AND WILL, IN NO WAY, AFFECT YOUR POSSIBLE EMPLOYMENT WITH CROOKER CONSTRUCTION, LLC.

Additional Notes