DRIVER / MECHANIC APPLICATION FOR EMPLOYMENT Dodge Concrete Inc. W6911 Silver Creek Road Watertown, WI 53098

Transcription

1 DRIVER / MECHANIC APPLICATION FOR EMPLOYMENT Dodge Concrete Inc. W6911 Silver Creek Road Watertown, WI Applicant s Name (Print) Date of Application In compliance with Federal and State equal opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status. To be Read and Signed by Applicant I certify that all information on this application is true, complete, and correct to the best of my knowledge. I understand that any false or misleading statements by me, or material omissions of information requested of me, may result in rejection of my application or, if employed, my immediate dismissal. I authorize you to make such investigations and inquiries of my personal, employment, financial, driving record, 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. A photocopy of this release shall be as valid as the original, and may be relied upon by all persons providing information. 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 (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 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. I understand that employment with this employer is not contractual and is at-will. I understand and agree that, if hired, I may voluntarily leave employment at any time and may be terminated at any time without prior notice for any reason or for no reason. I understand that any oral or written statements, which I may claim to have been made to me now or in the future inconsistent with the provisions of this paragraph, are expressly disavowed and revoked by the company, and should not be relied upon by me as an applicant for employment or as an employee, if hired. I certify that I have read (or have had read to me) and understand this Authorization, Release, and Certification Signature: Date: APPLICANT TO COMPLETE (Answer all questions. Please Print) Position(s) Applying for: Applicant Name: (Last) (First) (M.I.) Phone Number(s): (Home) (Mobile)

2 Do you have the legal right to work in the United States? YES NO Date of Birth (Required by Commercial Drivers (CDL) Only): Can you provide proof of age? YES NO List your addresses of residency for the past three years. Current Address Previous Addresses of Residence DRIVING EXPERIENCE -- CIRCLE Y(ES) OR N(O) CLASS OF EQUIPMENT CIRCLE TYPE OF EQUIPMENT FROM (Mo./Yr.) DATES TO (Mo./Yr.) APPROX. NUMBER OF MILES (TOTAL) STRAIGHT TRUCK Y N (Van, Tank, Flat, Dump, Refer) TRACTOR AND SEMI-TRAILER Y N (Van, Tank, Flat, Dump, Refer) TRACTOR-TWO TRAILERS Y N (Van, Tank, Flat, Dump, Refer) TRACTOR-THREE TRAILERS Y N (Van, Tank, Flat, Dump, Refer) MOTORCOACH-SCHOOL BUS Y N MOTORCOACH-SCHOOL BUS Y N NO MORE THAN 8 PASSENGERS OTHER EDUCATION High School: Address: Attended from: to Did you graduate? Y N If no, did you receive your GED? Y N 2

3 EDUCATION (CONTINUED) College: Address: Attended from: to Did you graduate? Y N If yes, what is your degree? If no, what is your general course of study? Other: Address: Attended from: to Did you graduate? Y N If yes, what is your degree? If no, what is your general course of study? EXPERIENCE, QUALIFICATIONS, AND EDUCATION OTHER List special courses or training that will help you as a driver/mechanic: Which safe driving awards do you hold and from whom? 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): In accordance with Federal Motor Carrier Safety Regulation (FMCSR) Section 40.25, the following questions relate to pre-employment drug/alcohol tests administered by any employer to which you applied for a driving position but were not hired within the last two years. - Have you tested positive for a pre-employment drug test? Y N - Have you tested positive for a pre-employment alcohol test? Y N - Have you refused to take a pre-employment drug test? Y N 3

4 REFERENCES Give names of three persons not related to you, whom you have known at least one year. Full Name: Relationship: Company: Phone: Address: Full Name: Relationship: Company: Phone: Address: Full Name: Relationship: Company: Phone: Address: Are you currently employed? Y N If no, how long since leaving last employment? If yes, may we contact your current employer? Y N Who referred you? Rate of pay expected: Have you ever been convicted of a felony? Y N If yes, please explain fully on a separate sheet of paper. Conviction of a crime is not an automatic bar to employment all circumstances will be considered. Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the attached job description)? Y N If yes, explain if you choose to do so: EMPLOYMENT HISTORY All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding three years. List complete: mailing address, street number, city, state, and zip code. Applicants to drive a commercial motor vehicle (including vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding) in intrastate or interstate commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such vehicle. The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 lbs. or more, (2) is designed or used to transport nine or more passengers, or (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding. 4

5 List all employers in reverse order, starting with the most recent. Add another sheet if necessary. WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE DRUG AND 5

6 This page to be filled out by candidates applying for a CDL position only. ACCIDENT RECORD Please include the past five years or more, if none, write NONE. Attach a separate sheet if more space is needed. DATES NATURE OF ACCIDENT FATALITIES INJURIES HAZARDOUS (HEAD-ON, REAR-END, UPSET, ETC.) MATERIAL SPILL LAST ACCIDENT NEXT PREVIOUS NEXT PREVIOUS NEXT PREVIOUS TRAFFIC CONVICTIONS and forfeitures for the past five years (other than parking violations). If none, write NONE. LOCATION DATE CHARGE PENALTY EXPERIENCE AND QUALIFICATIONS-DRIVER List all driver licenses or permits held in the past five years. STATE LICENSE NUMBER TYPE EXPIRATION DATE DRIVER LICENSES HAVE YOU EVER BEEN DENIED A LICENSE, PERMIT, OR PRIVILEGE TO OPERATE A MOTOR VEHICLE? Y N HAS ANY LICENSE, PERMIT, OR PRIVILEGE EVER BEEN SUSPENDED OR REVOKED? Y N IF THE ANSWER TO EITHER OF THE ABOVE QUESTIONS IS YES, GIVE DETAILS: COMMENTS (OPTIONAL) 6

7 JOB DESCRIPTION READY MIX TRUCK DRIVER This is the Task and Duty List for your position at Dodge Concrete, Inc. It provides you with important facts about your position. Identified just below is a brief description of the specific tasks and duties that are expected of a person accepting this position. Your performance will be evaluated based upon how well you perform these tasks and duties. POSITION: Driver TITLE OF MANAGER: Plant Manager Dispatcher BRIEF JOB DESCRIPTION: Safe, courteous, efficient delivery of concrete. SKILLS, KNOWLEDGE, AND ABILITIES: Ability to communicate in English, as well as read, write, and comprehend English. Ability to add, subtract, multiply, and divide. PHYSICAL REQUIREMENTS: Ability to left at least 100 lbs. unassisted, fully operate a large truck, hear ordinary personal and phone conversations, and correctable vision to 20/40. OUTSIDE TRAINING: Previous driving experience or training will be provided. LICENSES AND CERTIFICATIONS: Valid Wisconsin Commercial Class BCD Driver s License, Medical Card or Grandfathered if applicable, and pass a DOT Drug Screening Test. DESCRIPTION OF TASKS AND DUTIES: - Clock in at the start of each day. - Check out your truck as per pre-start, pre-trip inspection. - Move your truck into position for loading. - Deliver the load to customer s sites in a safe and courteous manner. Upon arriving at a customer s site, determine where the load is to be delivered. - Deliver the load as per instructions. Upon completion clean the truck as per instructions. - When you leave the customer fill out and sign the sales order. - Keep the dispatcher advised or your schedule including if you are running late or anticipate or incur any problems. Call the dispatcher when you leave the site with an estimated time of arrival back at the plant. Be aware that during busy times, the dispatcher may request that you load at another plant. Be courteous and considerate in your conversations with customer s personnel. - At the end of the day, park your truck appropriately, walk around the truck and check for damage. Complete post-trip inspection. Put the keys in the designated location. Inform the dispatcher of any non-routine maintenance or repair work required. Clean up your truck at the end of the day to have it ready to use the next day. If is your responsibility to maintain a safe and clean truck. - Drive carefully and courteously at all times. - Be available for Saturday and Sunday work as required year round. - Maintain proper timecard records when hauling loads for other plants other than the driver s home based plant. - Clean the break room on a regular rotational basis, for one week at a time. - During non-busy times, assist as necessary in yard work or maintenance work as scheduled, including filling the plant by operating the loader, cleaning and moving blocks, assisting customer, repair trucks, and repairing the plant. - Comply with the company dress code at all times while working. - BE AWARE OF AN ADHERE TO THE DRUG AND ALCOHOL ABUSE POLICIES OF THE COMPANY. - Always keep the Plant Manager-Dispatcher informed well in advance anytime you will not be able to report for work. - Report all accidents to your supervisor. Be sure to follow accident reporting procedures. - Attend mandatory company meetings (which are compensated at the regular hourly rate). - Report any traffic citations per DOT section Driver s Mandatory Notification. - Because of the nature of the business of the company, this position may be subject to temporary layoff. The decision of which driver(s) to furloughed is completely at the discretion of the management of the company. 7