Signature of Applicant* Date* Your Name* Email* Your Full Address (including city and state)* Phone Number* Position(s) Applied for* Salary Requirements* Full time?Part time? Hours Available* Date Available for Work* Are You At Lest 18 Years Old? YesNo Were you previously employed by us? YesNo If Yes, when? Are there any circumstances that could prevent you from being at work on our regular work hours? YesNo How did you happen to apply at Crooker Construction, LLC? Were you referred by a current Crooker Construction or Precast of Maine employee? YesNo If yes, who? Education: List All Schools Attended Name and Address of School High/Prep Graduate? YesNo Name and Address of School College Graduate? YesNo Degree Curriculum/Major Special Skills: Please list special skills/abilities (i.e., equipment or mechanical experience, licenses, software familiarity, etc.) Employment History: List employment history beginning with your two most recent positions. Employer #1 Present/Most Recent Employer* Phone* Address* Supervisor* Nature of Business* Starting Date* Ending Date* Title(s) and Description of Duties* Reason(s) for leaving* Which duties would you have preferred to have done more of?* Which duties would you have preferred to have done less of?* Employer #2 Present/Most Recent Employer Phone Address Supervisor Nature of Business Starting Date Ending Date Title(s) and Description of Duties Reason(s) for leaving Which duties would you have preferred to have done more of? Which duties would you have preferred to have done less of? Employer #3 Present/Most Recent Employer Phone Address Supervisor Nature of Business Starting Date Ending Date Title(s) and Description of Duties Reason(s) for leaving Which duties would you have preferred to have done more of? Which duties would you have preferred to have done less of? Driver's License Information Do you have a valid driver's license? YesNo Driver's License State: Driver's License Number: Addresses where applicant resided 3 years preceding application date: #1: Street, City, State, Zip #2: Street, City, State, Zip #3: Street, City, State, Zip Please complete if you have a commercial Driver's License (CDL) Information for Driver's Licenses Held In The Past 3 Years #1 State: License Number: Class: Endorsement(s): Expiration Date: Have you ever been denied a license, permit or privilege to operate a motor vehicle? YesNo Has any license, permit or privilege ever been suspended or revoked? YesNo Have you ever been disqualified for violations of Federal Motor Carrier Safety Regulations? YesNo If you answered "yes" to any of the above questions, please explain in the Additional Notes section at the bottom of this form. Driving Experience Straight truck Type of Equipment (Van/Tank/Flat/Dump) Dates (from & to) Approximate Total Miles Tractor and Semi Trailer Type of Equipment (Van/Tank/Flat/Dump) Dates (from & to) Approximate Total Miles Other Type of Equipment (Van/Tank/Flat/Dump) Dates (from & to) Approximate Total Miles Accident Review for the Past 3 Years #1 Date Nature of Accident (Head-On/Rear-End/Overturn, etc) Fatalities Injuries Additional Notes #2 Date Nature of Accident (Head-On/Rear-End/Overturn, etc) Fatalities Injuries Additional Notes If there are any additional accidents to report, please include them in the Additional Notes section at the bottom of this form. Traffic Convictions and Forfeitures for the past 3 years do not include parking violations #1 Location Date Charge Penalty #2 Location Date Charge Penalty If there are any additional traffic convictions to report, please include them in the Additional Notes section at the bottom of this form. Applicant's Name* Date* CROOKER CONSTRUCTION, LLC IS A FEDERAL GOVERNMENT CONTRACTOR/SUBCONTRACTOR AND IS REQUIRED TO REQUEST THE FOLLOWING INFORMATION FOR AFFIRMATIVE ACTION PURPOSES ONLY. Sex MaleFemale Race American Indian or Alaskan NativeBlack, Not of Hispanic OriginAsian or Pacific IslanderHispanicWhite, Not of Hispanic Origin PROVIDING THIS INFORMATION IS PURELY VOLUNTARY AND WILL, IN NO WAY, AFFECT YOUR POSSIBLE EMPLOYMENT WITH CROOKER CONSTRUCTION, LLC. Additional Notes Click Here to Upload you Resume in PDF or Word Doc Format. Having trouble with the form please call 207-837-6709. Δ
