D.I.J. Construction, Inc.

D.I.J. Construction, Inc.

Employment Application
Name *

First Name Last Name
Position Applying For *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Phone Number *

Area Code Phone Number
Emergency Contact
Name
Phone Number

Area Code Phone Number
Driver's License Request Form
Name as shown on Driver's License *

First Name Middle Name Last Name
Date of Birth *

Month Day Year
Date
License Number *
State *
Date of Expiration *

Month Day Year
Date
Driver's License Restrictions
Driver's License Endorsements
Drivers License Class *
Have You Been Issued a Traffic Citation in the last 7 years? *

Yes No
Please List All Traffic Citations from last 7 years
As a Driver, Have You Been Involved a Traffic Accident in the last 7 years? *

Yes No
Please List All Traffic Accidents from last 7 years
Education
High School Diploma or Equivalent?

Yes No
If No, Select Highest Grade Completed
Did You Attend College?

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College(s) Attended
Did You Graduate College?

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Degree
Special Skills or Training
Employment History
Company

Company Name

Street Address

City State / Province

Postal / Zip Code
Contact/Supervisor Name
May D.I.J. contact this person?

Yes No
Phone Number

Area Code Phone Number
Description of Duties
Dates of Employment

Start Date End Date
Reason for Leaving
Company

Company Name

Street Address

City State / Province

Postal / Zip Code
Contact/Supervisor Name
May D.I.J. contact this person?

Yes No
Phone Number

Area Code Phone Number
Description of Duties
Dates of Employment

Start Date End Date
Reason for Leaving
Company

Company Name

Street Address

City State / Province

Postal / Zip Code
Contact/Supervisor Name
May D.I.J. contact this person?

Yes No
Phone Number

Area Code Phone Number
Description of Duties
Dates of Employment

Start Date End Date
Reason for Leaving
Have You Ever Been Convicted of a Felony? *

Yes No
If Yes, Please Explain
Referred by:
Have You Previously Been Employed by D.I.J. Construction? *

Yes No
Dates of Previous Employment
From *

Month Day Year
Date
To *

Month Day Year
Date
I HEREBY DECLARE THE ABOVE INFORMATION IS COMPLETE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I AGREE THAT IF EMPLOYED MY EMPLOYMENT IS BASED ON THE FACTS GIVEN AND ANY INTENTIONAL MISREPRESENTATION ON MY PART WILL CONSTITUTE A RELEASE TO D.I.J. CONSTRUCTION, INC. FOR ANY LIABILITY THAT THE COMPANY MAY ENCOUNTER BY HAVING ACTED ON SUCH FACTS. I UNDERSTAND THAT IF EMPLOYED, ANY FALSE STATEMENTS CONTAINED ON THIS APPLICATION CAN BE CONSIDERED CAUSE FOR DISMISSAL. I HAVE READ THE ABOVE AND UNDERSTAND IT. I HEREBY AUTHORIZE D.I.J. CONSTRUCTION, INC. TO INVESTIGATE AND VERIFY THE FACTS CLAIMED BY ME ON THIS APPLICATION.
IT IS FURTHER UNDERSTOOD THE ABOVE INFORMATION IS REQUESTED FOR THE PURPOSE OF OBTAINING A MOTOR VEHICLE REPORT FROM DEPARTMENT OF PUBLIC SAFETY AS REQUIRED BY OUR INSURANCE CARRIER.

THE REPORTED INFORMATION WILL BE USED FOR THE PURPOSE OF DETERMINING INSURABILITY AND MEETING THE REQUIRED DRIVER LICENSE CLASS AS SET FORTH IN THE JOB DESCRIPTION AND PHYSICAL DEMAND REQUIRMENTS OF THE POSITION APPLIED FOR.

BY MY SIGNATURE BELOW I ATTEST THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS AND I HERBY GIVE D.I.J. CONSTRUCTION, INC. PERMISSION TO REQUEST THE MOTOR VEHICLE REPORT.
Signature *

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D.I.J. Construction, Inc.

Driver's License Request Form

Education

Employment History

Dates of Previous Employment