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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.

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Position You Are Applying For (Old dropdown)
Position You Are Applying For
Date
Referred By*
Personal
Name*
First Last
MI

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
MM slash DD slash YYYY
Commercial Drivers License Number
Class
State Issued
Expiration Date
MM slash DD slash YYYY
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 Actions
There are no Previous Employers.
Maximum number of previous employers reached.
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*
MM slash DD slash YYYY
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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

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

School Name	Subjects Studied	Did you graduate?	Years Attended

Name	Address	Phone

Employer Name	Actions

There are no Previous Employers.

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