SAUNDERS CONCRETE CO., INC. CORTLAND READY MIX CO., INC. CANASTOTA CONCRETE CO., INC. W.F. SAUNDERS & SONS, INC.

Transcription

1 SAUNDERS CONCRETE CO., INC. CORTLAND READY MIX CO., INC. CANASTOTA CONCRETE CO., INC. W.F. SAUNDERS & SONS, INC. We appreciate your interest in employment with our company. A Job Description for the position open is available for your review. Please answer all questions as thoroughly as possible to all review of the information in relation to employment with our company. We are an Equal Opportunity Employer. Employment related decisions are never based on race, gender, national origin, age, sexual orientation, marital status, labor affiliation, disability, veteran status, job related felony conviction or any other protected status. Our company retains fully completed Employment Application forms completed by individuals qualified for positions that may become for nine months after receipt. Any applicant who falsifies information on this Employment Application will be disqualified from being hired. If an employee has been hired before the falsification is discovered, the employee will be immediately terminated from employment on that basis. Any applicant who omits information in this Employment Application may be disqualified for being hired. If an employee has been hired before the omission is discovered, the employee may be terminated from employment on that basis. Final consideration for this position requires the following if the box is checked: Possession of a current, valid New York State Driver License, free from major infractions and acceptable to our insurance carrier. Must possess this license for employment as a driver and as an occasional driver of company vehicles. Possession of a current Commercial Drivers License. Passing a post offer/pre work drug and alcohol test. Ability to have your own transportation to a work site. PERSONAL INFORMATION Name Social Security No. Last First Middle Address No. Street City State Zip Telephone Number(s) you can be reached at ( ) Are you legally employable in the U.S.A.? Yes No Are you at least 18 years of age? Yes No Specific Position applying for: Expected rate of pay $ /hr. Are you applying for? full time part time Have you ever been employed by our company? Yes Specific days and hours available: No Dates: Position:

2 THE SAUNDERS COMPANIES CDL DRIVER APPLICATION ADDENDUM NAME (PRINT) Date The following information will be used only if directly related to the position for which you are applying. YES NO 1. Do you have at least two years licensed driving experience? 2. Do you have a valid driver's license? 3. Can you perform the job-related requirements of the specific job for which you are applying? 4. Are you willing and able to secure an NY Commercial Driver's License, if one is required? 5. Will you have reliable transportation to work? 6. Have you had any accidents in the last five years?. 7. Have you been cited for any moving violations in the last three years? 8. Have you been convicted of any felony? If you have answered "YES" to question 6, 7, 8 or 9, or "NO" to any of the other questions, please explain fully below, indicating by number to which question you are responding. BACKGROUND CHECK APPLICANT QUESTIONAIRE REGARDING PREVIOUS DRUG AND ALCOHOL TESTING INFORMATION APPLICANT: PLEASE CIRCLE YES OR NO IN RESPONSE TO THE FOLLOWING QUESTIONS AS REQUIRED BY U.S. DEPARTMENT OF TRANSPORTATION REGULATONS (49 CFR PART 40). IN THE PAST TWO YEARS: 1. Have you had any DOT required alcohol tests with a result of 0.04 or higher alcohol concentration? YES / NO 2. Have you had any verified positive DOT required drug tests? YES / NO 3. Have you refused to be tested (including having a verified adulterated or substituted drug test result)? YES / NO 4. Have you had any other violation of a DOT agency drug or alcohol testing regulation? YES / NO 5. Were there any situations in which you tested positive on a pre-employment test for a DOT employer that did not hire you? YES / NO 6. Were there any situations in which you refused to submit (including any adulterated or substituted findings) to a pre-employment test for a DOT employer that did not hire you? YES / NO I certify that my responses to the above questions are true: Applicant's Signature: Printed Name: Date: SSN:

3 CDL DRIVER APPLICATION ADDENDUM CONSENT FOR A RELEASE OF DRUG AND ALCOHOL TESTING INFORMATION AND TREATMENT RECORDS PLEASE PRINT Applicant Name: SSN: APPLICANT: IF YOU WERE EMPLOYED BY A DOT REGULATED EMPLOYER DURING THE LAST TWOYEARS AND PERFORMED A SAFETY SENSITIVE FUNCTION FOR THAT EMPLOYER, PLEASE PROVIDETHE NAME OF THAT EMPLOYER, A COMPLETE MAILING ADDRESS, AND PHONE NUMBER STARTINGWITH THE AREA CODE. START WITH THE MOST RECENT EMPLOYER FIRST

4 I,(print name) authorize my above listed previous employers to release to The Saunders Companies, 5126 South Onondaga Rd., Nedrow,NY 13120, phone (315) or fax (315) any verified positive drug test results, any alcohol test result of 0.04 or greater, any refusal to test (including verified adulterated or substituted drug test results), and information on any required substance abuse professional evaluation, determination of need for assitance and complicance with these recommandations for the preceding two years. I request these records be released immediately. This authorization is valid unitil withdrawn be me in writing. Dated this of, (Today's Date) (Month) (Year) Name of Applicant: Date: Signature of Applicant: Date: W.F. Saunders and Sons is an equal opportunity employer

5 CDL DRIVER APPLICATION ADDENDUM REQUEST FOR DRIVER INFORMATION PRINT ALL INFORMATION LEGIBLY This document must be fully completed for The Saunders Companies to obtain a Motor Vehicle driver Report. DRIVER INFORMATION NAME: LAST FIRST INITIAL ADDRESS CITY STATE ZIP CODE TELEPHONE NUMBER(S) YOU CAN BE REACHED AT DRIVER LICENSE INFORMATION Driver's License Number Social Security Number State Date of Birth List all States in which you have had an Operator's License DRIVER RELEASE I,, hereby Authorize W.F. Saunders and Sons, Fletcher Gravel, Saunders Concrete Company, Cortland Ready-Mix, Canastota Concrete Company, and/or Dorwin Springs Building Supply to request a copy of my Motor Vehicle Driver's Report. In addition, should my apllication be accepted for employment and/or upon my becoming an employee for W. F. Saunders and Sons, Fletcher Gravel, Saunders Concrete Company, Cortland Ready-Mix, Canastota Concrete Company, and/or Dorwin Springs Building Supply, I further authorize any/all additional requests for my Motor Vehicle Record be submitted and reviewed as needed for the sole purpose of my continued evaluation and eligibility standards under the State and Federal regulatory compliance standards. Signature of Driver Date SS# Date of Birth Driver License # Ordered By and for Future Employment Purposes ONLY with W.F. Saunders & Sons Human Resources Department 5126 South Onondaga Road Nedrow, NY 13120

6 CDL DRIVER APPLICATION ADDENDUM Please provide us with traffic violations and accident information for the last five years. Any deletions or omissions will be sufficient reason for denial of your application. TRAFFIC VIOLATIONS DATE STATE TYPE OF VIOLATION POINTS OR PENALTY ACCIDENT INFORMATION DATE PERSONAL NATURE OF ACCIDENT AT-FAULT INJURIES FATALTY COST OR NOT AT-FAULT COMMERCIAL DETAILS: DETAILS: DETAILS: I certify that my responses to the above questions are true: Applicant's Signature: Date: Printed Name: SSN: