Commercial Driver Online Employment Application
                      
Pressing the 'Submit' button at the bottom of this page will send this Employment Application to Slurry Pavers, Inc. for review.  If you have any questions or concerns, please contact Slurry via phone at (800) 966-1812 or email at jobs@slurrypavers.com.
Applicant: Read and sign before submitting this application.
The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.

I understand that the information in this application will be used and that prior employers will be contacted for purposes of investigation as required by Section 391.23 of the Federal Motor Carrier Safety Regulations.

Signature Of Applicant: Date:

Name: Phone: Social Security #:

List Addresses For Past Three Years.
Current Address: City, State Zip: How Long:
Previous Address: City, State Zip: How Long:
Previous Address: City, State Zip: How Long:
Previous Address: City, State Zip: How Long:
Date Of Birth:

In Case Of Emergency Notify:
Name: Address: Telephone #:

Position Applied For:
Have You Worked For This Company Before:
Yes
No
 		If Yes, Where?
From Date: To Date: Rate Of Pay: Position:
Reason For Leaving:
Names Of Relatives In Our Employ:
Are You Now Employed?
Yes
No
 		If Not, How Long Since Leaving Last Employment?
Who Referred You? Rate of Pay Expected:

Driving Experience
Class Of Equipment: Type of Equipment: From Date: To Date: Approx. No. Of Miles:
Straight Truck
Tractor or Semi-Trailer
Twin-Trailer
Other

Select Highest Grade Completed:
Elementary 1 2 3 4 5 6 7 8
High School 9 10 11 12
College 1 2 3 4
Last School Attended:
Name: Address:

Experience and Qualifications - Driver
Driver Licenses (any held in past three years must be shown)
State: License #: Type: Date:
Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No
Has any license, permit or privilege ever been suspended or revoked? Yes No
Have you ever been disqualified subject to section 391 of Federal Motor Carrier Safety Regulations? Yes No
If the Answer to Any of the Above Questions is Yes, E-mail Statement Giving Details

Show Special Courses or Training that will Help You as a Driver:

Which Safe Driving Awards Do You Hold and From Whom?

Accident Review for Past Three Years
Dates: Nature of Accident: Fatalities: Injuries:
Last Accident:
Next Previous:
Next Previous:

Traffice Convictions and Forfeitures for the Past Three Years (other than parking violations)
Location: Date: Charge: Penalty:

Employment Record
Federal Regulations require the applicant to give the names and address of the applicant's employers during the three (3) years preceding the date of this application in addition to the other information requested. Also, a list of the applicant's employers during the seven (7) year period preceding the three (3) years mentioned above, for which the applicant was employed as an operator of a commercial vehicle.

Last Employer:
Company: Supervisor's Name:
Address: Phone:
Position Held: From (Month/Year): To (Month/Year): Salary:
Reason for Leaving:
Second Last Employer:
Company: Supervisor's Name:
Address: Phone:
Position Held: From (Month/Year): To (Month/Year): Salary:
Reason for Leaving:
Third Last Employer:
Company: Supervisor's Name:
Address: Phone:
Position Held: From (Month/Year): To (Month/Year): Salary:
Reason for Leaving:
Company: Supervisor's Name:
Address: Phone:
Position Held: From (Month/Year): To (Month/Year): Salary:
Reason for Leaving:
Company: Supervisor's Name:
Address: Phone:
Position Held: From (Month/Year): To (Month/Year): Salary:
Reason for Leaving:
Company: Supervisor's Name:
Address: Phone:
Position Held: From (Month/Year): To (Month/Year): Salary:
Reason for Leaving:
Company: Supervisor's Name:
Address: Phone:
Position Held: From (Month/Year): To (Month/Year): Salary:
Reason for Leaving:
Company: Supervisor's Name:
Address: Phone:
Position Held: From (Month/Year): To (Month/Year): Salary:
Reason for Leaving:
Company: Supervisor's Name:
Address: Phone:
Position Held: From (Month/Year): To (Month/Year): Salary:
Reason for Leaving:
Company: Supervisor's Name:
Address: Phone:
Position Held: From (Month/Year): To (Month/Year): Salary:
Reason for Leaving:

To Be Read and Signed by Applicant

It is agreed and understood that any misrepresentations of information given above shall be considered an act of dishonesty and grounds for dismissal.
It is agreed and understood that the employer or his agents may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his furnishing such information.
It is also agreed and understood that under the Fair Credit Report Act, Public Law 91-508, I have been told that this investigation may include an Investigating Consumer Report, including information regarding character, general reputation, personal characteristics, and mode of living.
I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.
It is agreed and understood that this application for employment in no way obligates the employer to employ me; and it is understood that if hired, I will be on a 30 day probationary period during which I may be discharged without recourse.
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.

Company Safety Policy: It shall be the policy of SLURRY PAVERS, INC., to furnish employees a place of employment free from recognized hazards that are likely to cause death or physical harm to employees, and to comply with the Occupational Safety and Health Standards as provided for by the Occupational Safety and Health Act of 1970.

Employee's General Safety Rules: All work shall be planned and supervised to insure safe working conditions at all times. Federal Standards for safe practices shall be enforced. Supervisors and foremen shall insist on employees observing every safe standard and shall take disciplinary action to obtain complete observance.

Safe Work Practices:
  1. Wear clothes suited to your job. Dangling or loose clothing can catch in equipment, machinery or tools and cause serious injury.
  2. If you do not know how to do your job safely --- before starting work --- ask your foreman for instructions.
  3. You must wear personal protective equipment that the job requires, such as hard hats, goggles, safety belts, where a possible danger exists. Use all safeguards provided; see that they are in place and functioning. Report deficiencies to your foreman.
  4. You shall observe safe practices and report unsafe conditions to your foreman.
  5. You must be aware of fellow employees and observe practices that will not result in injury.
  6. You shall not indulge in horseplay or scuffling on the job.
  7. You must report any injury to your foreman immediately for treatment.
  8. You shall keep your mind on the job at hand; "day dreaming" causes injuries.
  9. You shall ask your foreman for special instructions regarding unfamiliar conditions encountered or potential dangerous energy sources, such as gas lines, electrical lines, steam lines, water lines, dynamite, etc.

Tools and Equipment:
  1. Personal tools such as hammers and chisels, etc. shall be kept well dressed to prevent injury from flying particles.
  2. Company-owned tools shall be kept in good condition. Report any deficiency to your foreman, such as dull blades, missing or broken guards, frayed wiring, etc.
  3. Use the proper tool for the job.
  4. All electrical tools shall be properly grounded. All power tools must be used in accordance with safe practices and shall be manufactured as specified in the Federal Standards whether personally owned or company owned.
  5. Use tools and equipment in the proper manner. Ask foreman for instructions if you are not sure. Do not risk injury to yourself or others by improper use of tools.

Machinery and Vehicles:
  1. Do not operate machinery or equipment without permission from your foreman.
  2. Do not start equipment, operate valves, or electrical switches until you make sure it is safe to do so.
  3. Do not repair or adjust machinery while it is in operation. Only specifically trained mechanics shall make adjustments or repairs that rewire the machine to be in operation. Consult your foreman if these adjustments are necessary.
  4. Never work under machinery or equipment supported by jacks or chain hoists without protective blocking.
  5. Do not operate machinery or equipment unless you are trained and qualified. Observe all safety practices and rules while operating machinery or equipment.
Signed: Date: