Employment at DePuy Paving, Inc.

You may fill out the form below with your employment history or click one of the links below to print and fill out by hand:

In compliance with Federal and State equal employment 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.

Name: Social Security No.:
Present Address:
Previous Address:
Telephone Number: Cell Phone:
Do you have a legal right to be employed in the United States?
(proof reqd.)
Are you over the age of 18?
General Information
Are you currently employed? If not, date of last employment?
Type of position seeking: (Note: all positions are seasonal)
Who referred you? Rate of pay anticipated
Ohio Operators And CDL Licensing
Do you currently hold a valid Ohio Driver's License?
Do you currently hold a valid Ohio Commercial Driver's License (CDL)?
Do you have any special endorsements on your CDL? If yes, please list:
Do you have any moving violation, restrictions and/or points against your driver's license affecting your employment which would render you uninsurable or qualify you as a high risk driver?:
What is your Ohio Drivers License Number:
When are you available to begin employment?:

All CDL applications must complete the CDL authorization in compliance with federal law to release any prior alcohol and drug testing results from previous employers.

Educational Background
Type of School Name and City Graduated?
College
Technical School
High School
Other
Special Skills Related to Position for which you are Applying
Position Experienced Company Years
Bobcat Operator:
Roller Operator:
Asphalt Paver Operator:
Sealcoating:
Crackfill Application:
Concrete Installation:
Curbing/Dumpster Pads
Concrete Installation:
Catch Basins/Sidewalks
Concrete Installation:
Handicap Ramps/Approaches
Mechanical Repair:
Other Skills:

Motor vehicle driving records affects all applications; if a person is deemed uninsurable by our commercial liability insurer it would prohibit us from hiring you if your position requires operating a company owned motor vehicle or equipment. State of Ohio law requires all drivers have vehicle/automobile insurance coverage, therefore if you are uninsurable, State law prohibits you from operating a motor vehicle and thus prevents us from hiring you.

List Present and Past Employment, Beginning with Most Recent
1. Company: Dates Worked:
From: To:
Address:
Street       City        State       Zip
Phone: Name of Supervisor:
Type of Business: Position Held:
Duties/Responsibilities:
Reason for Leaving:
Starting Wage: Ending Wage:
2. Company: Dates Worked:
From: To:
Address:
Street       City        State       Zip
Phone: Name of Supervisor:
Type of Business: Position Held:
Duties/Responsibilities:
Reason for Leaving:
Starting Wage: Ending Wage:
3. Company: Dates Worked:
From: To:
Address:
Street       City        State       Zip
Phone: Name of Supervisor:
Type of Business: Position Held:
Duties/Responsibilities:
Reason for Leaving:
Starting Wage: Ending Wage:
Work References
1. Name: Relationship and Title:
Company & Address:
Home Phone: Cell Phone: Work Phone:
Years Known:
2. Name: Relationship and Title:
Company & Address:
Home Phone: Cell Phone: Work Phone:
Years Known:
3. Name: Relationship and Title:
Company & Address:
Home Phone: Cell Phone: Work Phone:
Years Known:
Applicant Must Read and Digitally Sign

I certify that I have read and understand all of this employment application. It is agreed and understood that the employer or his agent may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or not, and I release employers and other persons named herin from all liability for any damages on account of furnishing such information. Background search of past or present motor vehicle driving record is included. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a physical examination and or drug test.

I further certify that I am a genuine applicant for employment and this applications is being submitted solely for the purpose of seeking employment with the employer and for no other reason.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal.

If hired, I agree to abide by all the rules and policies of the employer.

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

Signed:
(type full legal name)
Date:
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