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APPLICATION

CONTACT INFORMATION

Please answer the following questions. If not applicable, please list N/A.

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

If you don't have a valid email address, please use "Your First.Last Name@donotreply.com". Please understand that employers may not be able to contact you without a valid email address.

Social Security Number *

How did you hear about this job? *

Date available to start *

Are you available to work (select all that apply) *

Full Time Seasonal Summer Only Overtime (including weekends)

Have you ever worked for Hansen Asphalt before? *

Have you ever applied to Hansen Asphalt before? *

Position Desired *

DESIRED RATE OF PAY *

List any craft training or special courses taken: *

DRIVING INFORMATION

Drivers License Number *

Do you have a Commercial Driver License? *

If yes, how long have you had your CDL? *

Driver License Class (CDL only) *

State of Issue *

Expiration Date (dd/mm/yyyy) *

Endorsements *

Type of truck/equip you can operate/repair. List years of exp. for each *

WORK EXPERIENCE

Are you currently employed? *

PROVIDE YOUR WORK HISTORY FOR (AT MINIMUM) THE LAST 3 YEARS TO THE PRESENT.

Job Title *

Company Name *

Start Date MM/YYYY *

End Date MM/YYYY *

Immediate Supervisor *

Supervisor's Phone Number *

May We Contact Previous Employer? *

Pay Rate *

Job Description *

Special Skills, Equipment, and Certifications: *

Reason for leaving *

Job Title *

Company Name *

Start Date MM/YYYY *

End Date MM/YYYY *

Immediate Supervisor *

Supervisor Phone Number *

May We Contact Previous Employer? *

Pay Rate *

Job Description *

Special Skills, Equipment, and Certifications: *

Reason for Leaving *

Job Title *

Company *

Start Date MM/YYYY *

End Date MM/YYYY *

Immediate Supervisor *

Supervisor Phone Number *

May We Contact Previous Employer? *

Pay Rate *

Job Description *

Special Skills, Equipment, and Certifications: *

Reason for Leaving *

EDUCATION

HIGH SCHOOL

Name & Location of school *

Years Attended *

Did you graduate? *

Degree *

COLLEGE

Name & Location of school *

Years Attended *

Did you graduate? *

Degree *

TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL

Name & Location of school *

Years Attended *

Did you graduate? *

Degree *

REFERENCES

Please list two persons not related to you that we may call/email for reference. If you don't have a valid email address for your reference, please use "Your First.Last Name@donotreply.com". Please understand that employers may not be able to contact your reference without a valid email address.

Name *

First

Last

Phone Number *

Job Title *

Email *

Relationship to you *

Name *

First

Last

Phone Number *

Job Title *

Email *

Relationship to you *

ACCIDENT RECORD

Please list your accident record for the past 5 YEARS. If not applicable, select "NO" from the dropdown.

Have you had any accident(s) in the last 5 years? *

If YES, answer all of the following in the box below:
1. Date of accident
2. Type of accident (example: rear end, head on)
3. Were there fatalities
4. Were there injuries
Include ALL accidents in the last 5 YEARS.
If you answered NO type "N/A" in the box below.

Comment *

TRAFFIC CONVICTIONS

Please list any traffic convictions/forfeitures (other than parking violations) for the past 5 years. If not applicable, select "no".

Have you had any traffic convictions/forfeitures in the last 5 years? *

If YES, answer all of the following in the box below:
1. Date of traffic conviction/forfeiture
2. Location
3. Charge
4. Penalty/Fine
Include ALL traffic convictions/forfeitures in the last 5 YEARS.
If you answered NO, type "N/A" in the box below

Comment *

AUTHORIZATION

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment"

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

Authorization Statement Acknowledgement *

I have read the authorization statement

Electronic Signature (Type full name here) *

Date (MM/DD/YYYY) *

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Submit

APPLY HERE

APPLICATION

CONTACT INFORMATION

DRIVING INFORMATION

WORK EXPERIENCE

EDUCATION

REFERENCES

ACCIDENT RECORD

TRAFFIC CONVICTIONS

AUTHORIZATION