Employment Opportunities Important! All fields are required, do not leave a field blank, please enter N/A if an answer is not applicable. Online Application for Employment Personal Information: Applicant Name Email Address (required) Address City     State   Zip   Phone Referred By Employment Desired: Position Date You Can Start Salary Desired Are you employed? Yes   No If so, may we inquire of your present employer? Yes   No Ever applied to this company before? Yes   No If so, When? Tractor/Trailer Experience/Operated: Equipment You Can Operate: Other Skills: Training & Certification: Important! All fields are required, do not leave a field blank, please enter N/A if an answer is not applicable. Driver's License:  (Only nesessary if a license is required for the position sought) Date of Issue Is it a Valid License? Yes   No Issuing State CDL (required for truck drivers) Yes   No Endorsements Date of Birth Education: High School Name & Location of School Years Attended Date Graduated Education: College/Trade School Name & Location of School Years Attended Date Graduated Subjects Studied The AGE DISCRIMINATION IN EMPLOYMENT ACT OF 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age. Important! All fields are required, do not leave a field blank, please enter N/A if an answer is not applicable. In Case of Emergency, Notify Name Address Phone Former Employers  (List employers for the preceding 3 years, starting with last one first) Employer 1 Date, Month & Year From   To Name, Address & Phone Salary/Hourly Wage Position Reason for Leaving Employer 2 Date, Month & Year From   To Name, Address & Phone Salary/Hourly Wage Position Reason for Leaving Employer 3 Date, Month & Year From   To Name, Address & Phone Salary/Hourly Wage Position Reason for Leaving Important! All fields are required, do not leave a field blank, please enter N/A if an answer is not applicable. References  (Give the names of three persons not related to you, whom you have know at least one year) Reference 1 Name Address Business Years Known Reference 2 Name Address Business Years Known Reference 3 Name Address Business Years Known Special Matters As required under the Immigration Reform And Control Act, any persons wishing to work for Central Paving, Inc., regardless of the nature of the job or the number of hours or months employed, will be required to show proof of his/her identity ans U.S. Citizenship or legal authority to work in the U.S. prior to beginning employment. Do you legally have the right to work in the U.S.?   Yes   No Can you perform the essential functions of the job that you are applying for with or without reasonable accommodations?   Yes   No If you need reasonable accommodations to participate in the application process or interviewing session, please describe below:   Additional Information Enter additional information to fully describe your qualifications OR enter an N/A if no information is available. Important! All fields are required, do not leave a field blank, please enter N/A if an answer is not applicable. Online Signature By clicking "Continue" on this online application, I certify that all answers and statements on this application are true and complete. I understand that should an investigation disclose untruthful or misleading answers, my application may be rejected, my name removed from consideration, or my employment with Central Paving Co., Inc. terminated. I authorize Central Paving Co., Inc. by clicking "Continue" on this online application, to conduct or have conducted a background investigation, reference checks, Educational verification, and, if applicable a motor vehicle records check. I understand Central Paving Co., Inc. must provide, at my request, the name of the informational source so I may obtain from the source, the nature and substance of the information supplied to Central Paving Co., Inc. I understand that acceptance of an offer of employment does not create a contractual obligation upon Central Paving Co., Inc. to continue to employ me in the future. I understand that, if requested, I will have to submit to a physical examination with primary emphasis on back and leg condition. This is due to the heavy lifting required of the position and Central Paving Co., Inc.'s desire to keep accidents and injuries at a minimum. Employment may be contingent upon the results of the physical examination. I further understand that should employment be offered to me, I must submit a pre-employment drug-screen. Employment is contingent upon the results of the drug-screen.