Fayetteville Contractors, Inc. APPLICATION FOR EMPLOYMENT P.O. Box 610 CDL License Fayetteville, PA 17222-0610 Equal Opportunity Employer 717-352-2186 Date It is the policy of Fayetteville Contractors, Inc. that all applicants are treated without regard to their age, race, color, creed, national origin, religion, disability, veteran status, gender and/or other protected status. Home (Middle) (Maiden, if any) (Last) Cell How long? Date of Social Security Number Birth Current Driver’s License A B C Endorsements H N No Address for the past three years if different from above (Attach sheet if more space is needed) How long? How long? Would you take a physical examination? Job for with you are Wage expected applying Applying for: Full time No Part time work Yes No work Are you presently Yes No If yes, may we contact your employer Yes No employed? Have you had any special training in any job classification or If Yes, explain vocation? List three references (list no more than one relative) Address Address Address Experience and Qualifications - Driver Driver License No. Class/Endorsements Expiration Date License Driving Experience Dates Type of Equipment Approx. No. of Miles Class of Equipment From To (Total) (Van, Flat, Dump, Etc.) Straight Tractor & Tractor Two – Trailers Other Accident Record for past 3 years or more (attach sheet if more space is needed). If none, please indicate NONE. Nature of Accident Fatalities Injuries (Head-on, rear-end, upset, etc.) Traffic Convictions and Forfeitures for the past 3 years (other than parking violations) Date Location Charge Penalty Attached if more space is needed
Fayetteville Contractors, Inc. APPLICATION FOR EMPLOYMENT P.O. Box 610 CDL License Fayetteville, PA 17222-0610 Equal Opportunity Employer 717-352-2186 Date It is the policy of Fayetteville Contractors, Inc. that all applicants are treated without regard to their age, race, color, creed, national origin, religion, disability, veteran status, gender and/or other protected status. Home (Middle) (Maiden, if any) (Last) Cell How long? Date of Birth Social Security Number Current Driver’s License No A B C Endorsements H N Address for the past three years if different from above (Attach sheet if more space is needed) How long? How long? Would you take a physical examination? Job for with you are applying Wage expected Applying for: Full time work No Part time work Yes No Are you presently employed? Yes No If yes, may we contact your employer Yes No Have you had any special training in any job classification or vocation? If Yes, explain List three references (list no more than one relative) Address Address Address Experience and Qualifications - Driver Driver License License No. Class/Endorsements Expiration Date Driving Experience Class of Equipment Type of Equipment (Van, Flat, Dump, Etc.) Dates From To Approx. No. of Miles (Total) Straight Tractor & Tractor – Two Trailers Other Accident Record for past 3 years or more (attach sheet if more space is needed). If none, please indicate NONE. Nature of Accident (Head-on, rear-end, upset, etc.) Fatalities Injuries Traffic Convictions and Forfeitures for the past 3 years (other than parking violations) Date Location Charge Penalty Attached if more space is needed
Employment-Application-CDL-License.docx