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Phone: 207-498-6300 |
Fax: 207-498-6535
Hours: Monday-Friday: 6:00 - 5:00
[email protected]
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APPLICANT INFORMATION
Soderberg Construction Employment Application
First Name
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Last Name
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M.I.
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Date
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Current Street Address
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Apt. No.
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City
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State
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Zip Code
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Home Phone
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Date of Birth
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Are you a citizen of the United States?
Yes
No
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If no, are you authorized to work in the U.S.
(*)
Yes
No
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Have you ever worked for this company?
(*)
Yes
No
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If yes, when?
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Have you ever been convicted of a felony
(*)
Yes
No
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If yes, explain?
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What position are you applying for?
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Date you can start:
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EDUCATION
High School
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Address
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From
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To
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Did you graduate?
Yes
No
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Degree
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College
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Address
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From
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To
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Did you graduate?
Yes
No
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Degree
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Trade, Business, or Correspondence School
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Address
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From
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To
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Did you graduate?
Yes
No
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Degree
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REFERENCES
Full Name
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Relationship
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Company
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Phone
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Address
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Full Name
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Relationship
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Company
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Phone
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Address
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Full Name
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Relationship
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Company
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Phone
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Address
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PREVIOUS EMPLOYMENT
Company
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Phone
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Street Address
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Supervisor
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Job Title
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Starting Salary
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Ending Salary
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Responsibilities
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From
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To
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Reason For Leaving
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May we contact your previous supervisor for a reference?
Yes
No
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Company
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Phone
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From
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Street Address
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Supervisor
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Job Title
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To
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Starting Salary
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Ending Salary
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Responsibilities
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Reason For Leaving
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May we contact your previous supervisor for a reference?
Yes
No
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Company
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Phone
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Street Address
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Supervisor
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Job Title
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Starting Salary
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Ending Salary
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Responsibilities
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From
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To
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Reason For Leaving
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May we contact your previous supervisor for a reference?
Yes
No
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Licenses-Skills-Certifications
Licenses/Certifications or OSHA Credentials - Type:
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License Number
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State Of Issue
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Expiration Date
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Skills and Equipment you can operate
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U.S. Military Service
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Rank
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Present Membership in the National Guard or Reserves
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DRIVING QUALIFICATION AND EXPERIENCE
Licenses Held:
State
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License Number
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Type
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Expiration Date
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State
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License Number
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Type
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Expiration Date
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State
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License Number
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Type
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Expiration Date
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Equipment Experience
Tractor, Semi & Trailer
Equipment Type (Van, Flat, Tank, Reefer
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For How Long?
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Total Miles (Approx.)
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Tractor W/ Two Trailers:
Equipment Type (Van, Flat, Tank, Reefer
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For How Long?
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Total Miles (Approx.)
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Straight Truck:
Equipment Type (Van, Flat, Tank, Reefer
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For How Long?
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Total Miles (Approx.)
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Other:
Equipment Type (Van, Flat, Tank, Reefer
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For How Long?
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Total Miles (Approx.)
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In what states have you operated in the past three years?
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Have you ever had your license revoked or suspended?
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If so, when and where?
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Why? (Please explain)
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Have you tested positive for a pre-employment or random drug or alcohol test in the past two years?
No
Yes
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Accidents and Violations:
Accidents in the past three years (List most recent first)
Date:
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Injuries?
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Fatalities?
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Vehicle Type:
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Describe
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Date:
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Injuries?
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Fatalities?
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Vehicle Type:
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Describe
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Date:
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Injuries?
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Fatalities?
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Vehicle Type:
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Describe
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Traffic Convictions in the past three years (No parking violations)
Date:
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Injuries?
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Fatalities?
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Vehicle Type:
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Describe
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Date:
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Injuries?
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Fatalities?
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Vehicle Type:
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Describe
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Date:
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Injuries?
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Fatalities?
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Vehicle Type:
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Describe
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DISCLAIMER AND SIGNATURE
I certify that all the information submitted by me on this application is true and complete. I understand that employment is conditioned upon a background check and if any false information, omissions, or misrepresentations are discovered, my application will be rejected
If I am employed, my employment will be "At Will" and may be terminated at any time with or without cause and with or without notice. I also understand the terms and conditions of my employment may change at any time. If employed I agree to conform to all Soderberg's rules and regulations. I also agree to submit to any medical examination and drug test as teemed appropriate by the company.
I understand that the filling out of this application or the advent of an interview does not imply a promise for employment and does not obligate Soderberg's to hire. Only the President of the company can or will enter into an employment agreement.
Applicants for position that require driving a commercial motor vehicle (CMV) at any time will be required to undergo controlled substances and at our discretion, alcohol testing prior to employment and will be subject to further testing throughout the period of employment. Applicants will also be asked to sign forms for release of information from previous employers where driving a CMV was one of your functions. Failure to sign will prevent this employer from using you as a CMV driver.
Applicant Signature
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Date
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Applicant Email address
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This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination. We are an equal opportunity employer
Contact Details
Soderberg Construction Co.
460 York St.
Caribou, Maine 04736
Phone: 207-498-6300
Fax: 207-498-6535
Email:
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