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Employment Application Please fill out all fields!
First Name
Last Name
Address
Address
City
State
Postal Code
Email
Phone
Position Applying for
Do you have a valid State Driver's License?
Yes
No
Do you have a valid Class A or Class B Commercial Driver's License?
Class A
Class B
None
Do you have reliable transportation to and from work?
Yes
No
Are you a citizen of the United States?
Yes
No
Have you ever been convicted of a felony?
Yes
No
Previous Employer 1: Name and Location
Start and End Date(s) with Employer 1
Employer 1: Supervisor Name, Phone and Email
Job Title and Brief Description of Duties
Reason for Leaving Employer 1
Previous Employer 2: Name and Location
Start and End Date(s) with Employer 1
Employer 2: Supervisor Name, Phone and Email
Reason for Leaving Employer 1
Job Title and Brief Description of Duties
Functions of the Job may require lifting 50 to 80 lbs., pushing and/or pulling equipment and wheel barrows. Do you have any past or current reasons that would prevent you from completing these job functions?
Yes
No
Do you have experience driving a truck with a trailer?
Very experienced pulling trailers with truck
Some experience pulling trailers with truck
Experience driving trucks without trailer
Hand Tools, such as wheel barrows, shovels, levels, etc.
What are your salary expectations?
The statements made on my application are true and accurate. I understand that Blacktop Central may do a background check prior to employment and that I may be requested to submit a drug test at any time before or during my employment.*
Yes
No
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