Fischer Concrete Services

Basic Information

Name

SSN

Home Address

City

State

Zip Code

Home Phone

Other Phone

Position Applied For

Availability

Rate Of Pay Expected

Are you 18 years or older?

Are you lawfully authorized to work in the US?

Who referred you to Fischer Concrete Services?

Lifting Acknowledgement: If applying for a driver position you must be able to lift up to 60 lbs. on a regular basis, must be able to stoop, bend and work in extreme temperatures. Can you perform these essential job duties with or without accomodation?

Driving License

List all states in which you have held a driver's license (at least 3 years must be shown)

Have you ever been denied a license or privilege to operate a motor vehicle?

Has any license, permit or privilege ever been suspended or revoked?

Driving Experience

Straight Truck
Tractor Trailer
Other

Type

Date From

Date To

Approx. Miles

Safety Record: List all accidents for the past 5 years. Please describe.

Dates

Describe Accidents

Specialized Skills: (heavy equipment operator, mechanical maintenance, construction, forklift, etc.)

Dates

Type Of Skill / Experience

Education

Name Of School

Location

Dates Attended

Degree

Employment

Current Employer

Name

Phone

Full Address

ZIP

Position Held

From

Reason For Leaving

Ending Wage

Who may we contact to verify your employment?

Previous Employer

Name

Phone

Full Address

ZIP

Position Held

From

Reason For Leaving

Ending Wage

Who may we contact to verify your employment?

Next Previous Employer

Name

Phone

Full Address

ZIP

Position Held

From

Reason For Leaving

Ending Wage

Who may we contact to verify your employment?

References - List 3 professional references (do not list relatives)

Name

Street Address

City

Phone Number

Second Reference

Name

Street Address

City

Phone Number

Third Reference

Name

Street Address

City

Phone Number

Applicant - Please Read and Accept

I certify that I have read and understood the employment application, and I am submitting this application for the sole purpose of seeking employment with Fischer Concrete Services. It is agreed and understood that Fischer Concrete Services or its agents may investigate my background and employment history, whether the same is of record or not. I understand that this information will be used for the purpose of determining my eligibility for employment with Fischer Concrete Services. I authorize, without reservation, any party or agency contacted by Fischer Concrete Services to furnish requested information concerning my work history and character. I release all employers, USIS and other persons named herein from all liability for damages due to furnishing such information. I certify that this application was completed by me and all answers I have given are truthful to the best of my knowledge. I understand that any misrepresentations or omissions may result in my rejection for consideration or dismissal. I agree to furnish additional information and complete examinations, and drug and alcohol tests as may be required.

I Agree

Pre-Employment Testing Policy Acknowledgement (Contingent Upon Accepting Employment) - Please Read and Accept

I agree to reimburse Fischer Concrete Services the total cost of my pre-employment drug screening if one of the following should occur:

DOT Compliance Drug Test is returned with a positive laboratory result.
If I willingly leave employment with Fischer Concrete Services within 90 days of hire date.

I Agree

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