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Quarry Employment
Driver Application
Credit Application

Date

Personal Information

First Name *

Middle Name *

Last Name *

Email *

Home Phone *

Mobile Phone *

Are you at least 18 years of age? *YesNo

Do you have the legal right to work in the US? *YesNo

Are you willing to submit to drug screening if hired? *YesNo

Have you been convicted of a non-expunged felony? *YesNo

If you served in the US military, was your discharge honorable? *YesNoNot Applicable

What is the highest level of education you have completed? *No High School Diploma or EquivalentHigh School or EquivalentTechnical Diploma / CertificateAssociate DegreeBachelor DegreeMasters DegreeHigher than Masters Degree

What position you are applying for? *

How did you learn about this position? *If referred, include the employee’s name and your relationship.

Residency Information

Please provide your current address and any addresses where you have lived in the past three (3) years.

Full Address *

Duration at Address *

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Employment History

List your complete employment history for the past three (3) years, starting with your most recent position. Include all work types and any gaps in employment. Full details are required.

Company *

Full Address *

Supervisor *

Phone *

Your Position *

Start Date and Pay *

End Date and Pay *

Reason For Leaving *

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Employment References

Do you have any employment references you'd like to list? *YesNo

Full Name *

Title/Role *

Phone *

Full Address *

Add Reference Remove

By accepting this application, I acknowledge that I have read, understand, and agree to the statements below, and I: *

Acknowledgment & Authorization

(1) Certify that I personally completed this application and that all information provided in this application is true and complete to the best of my knowledge; agree that any omission, misrepresentation, falsification, or misleading information provided in this application or in any other communication to the Company justifies refusing to hire me or terminating my employment if discovered after I am hired; acknowledge that I understand that any conditional offer of employment may be revoked if I do not submit to and pass a pre-hire medical examination by a health care professional of the Company’s choosing, submit to and pass a pre-hire drug screening test, and cooperate fully with any such examinations and tests; and acknowledge that a background check may be required to verify my criminal, employment, education, and/or credit history, and I agree to cooperate fully to authorize such actions; and

(2) Acknowledge the information provided in this application, including information regarding my current and former employers, may be used, and those employers may be contacted, to investigate my work and safety performance history for the purpose of making employment decisions; authorize the Company to contact my current and former employers, educational institutions, references, and others for employment-related purposes; and understand I may be required to provide additional information; and

(4) Acknowledge that if I am hired my employment with the Company will be “at-will” and both the Company and I will be free to terminate the employment relationship at any time without notice and without cause, and that this “at-will” employment relationship can be changed only by an express written employment agreement signed by the Company’s President. I understand I will not be considered for employment with the Company unless I agree to the terms above. I, therefore, agree to those terms knowingly, voluntarily, and in exchange for the Company’s willingness to consider my application for employment.

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Date

Personal Information

First Name *

Middle Name *

Last Name *

Email *

Home Phone *

Mobile Phone *

What type of employment do you seek? *Full timePart timeOther

Available 7 days/week, including overtime? *YesNo

Shift(s) you are available to work? *FirstSecondThirdOther

Wage/Salary desired? *

If hired, on what date could you start? *

Are you willing to submit to drug screening if hired? *YesNo

Residency Information

Please provide your current address and any addresses where you have lived in the past three (3) years.

Address *

Duration at Address *

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Education

Enter the school name, location, grade or degree, and year(s) attended for each school or program.

School Name *

City and State *

Grade or Degree *

Year(s) Attended *

Add Education Remove

CDL / CLP Information

Provide all current, unexpired CDL or CLP information, including each state, license number, expiration date, class, and any restrictions.

Can you provide proof of age? *YesNo

Have you ever been denied a license, permit or privilege to operate a motor vehicle? *YesNo

Please describe the license, permit, or privilege denial. *

Has any license, permit or privilege ever been suspended or revoked? *YesNo

Have you ever been denied insurance to drive any type of motor vehicle? *YesNo

Please describe the suspension or revocation. *

Please describe the insurance denial. *

List all states in which you currently have a valid, unexpired CDL or commercial learners permit ("CLP")

State *

License Number *

Expiration Date *

CDL/Class *

Restrictions, If Any *

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Accidents

Have you been involved in any accidents in the last 3 years? *YesNo

Date *

Nature of Accident *

Number of Fatalities *

Number of Injuries *

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Traffic Convictions/Forfeitures

Have you had any traffic convictions or forfeitures in the last 3 years? *YesNo

Date *

City/State *

Charge *

Penalty *

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Employment Records

Provide your complete employment history for the past ten (10) years, starting with your most recent employer. Include all work, CMV employers, and any gaps longer than one (1) month. Full details are required; resumes may not be used. Information may be verified under 49 C.F.R. §§ 383.35 and 391.21.

Company *

Full Address *

Phone *

Supervisor *

Your Position/Title *

Class of Equipment *

Type of Equipment *

Approx Miles *

Start Date and Pay *

End Date and Pay *

Were you subject to the FMCRS’s while Employed? *YesNo

Was your job classified as safety-sensitive under DOT regulations and subject to drug and alcohol testing per 49 CFR part 40? *YesNo

Reason For Leaving *

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Employment References

Do you have employment references to list? *YesNo

Full Name *

Title/Role *

Phone *

Email Address *

Add Reference Remove

By accepting this application, I acknowledge that I have read, understand, and agree to the statements below, and I: *

Acknowledgment & Authorization

(2) Acknowledge the information provided in this application, including information regarding my current and former employers, may be used, and those employers may be contacted, to investigate my work and safety performance history for the purpose of making employment decisions, including, as required by 49 C.F.R. § 391.23; authorize the Company to contact my current and former employers, educational institutions, references, and others for employment-related purposes; and understand I may be required to provide additional information; and

(3) Authorize my current and former employers, and others, to give the Company information concerning my employment, and release my current and former employers from any liability whatsoever for providing such information; acknowledge that I have the right under 49 C.F.R. § 391.23 to: review information provided by my current and previous employers, have errors in the information corrected by those employers (including having those employers submit corrected information to the Company), and submit a rebuttal statement attached to the alleged erroneous information if my current or previous employer(s) and I cannot agree on the accuracy of the information; understand the Company will protect information provided by my current and previous employers from disclosure to other third parties and will use it only for employment decisions; and

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Date

Business Information

Complete Business Name *

Address *

Phone *

Email *

President/Owner *

Account Payable Contact *

Type of Business *IndividualCorporationPartnership

How long in Business *

Bank Reference

Name of Bank *

Account Number *

Address *

Phone *

Email *

Company References

List three references with whom you have had open account activities with for not less than 3 months (other carriers preferably)

Company Name *

Address *

Contact Name *

Phone *

Email *

Add Reference Remove

Your Information & Agreement

Your Name *

Your Email *

Position *

I agree to the following terms and policy. *

OPEN ACCOUNT TERMS AND POLICY

I authorize Robertson Crushed Stone, Inc. to obtain and review any information necessary to evaluate this credit application and establish an open account. I understand that this information will be used solely for credit evaluation and account administration purposes and will not be shared with third parties except as permitted by law.

If credit is approved, payment terms will be as stated on the invoice unless otherwise agreed to in writing. I understand that invoices are due according to the terms provided and that past-due accounts may be subject to credit review, credit hold, or additional requirements prior to future deliveries.

I acknowledge that Robertson Crushed Stone, Inc. may contact banks, trade references, and other sources as part of the credit review process. I certify that the information provided in this application is true, complete, and accurate to the best of my knowledge.

By submitting this application, I agree to comply with the Company’s credit terms and policies as they may be established or amended from time to time, in consideration of credit being extended.

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Personal Information

Residency Information

Please provide your current address and any addresses where you have lived in the past three (3) years.

Employment History

List your complete employment history for the past three (3) years, starting with your most recent position. Include all work types and any gaps in employment. Full details are required.

Employment References

Personal Information

Residency Information

Please provide your current address and any addresses where you have lived in the past three (3) years.

Education

Enter the school name, location, grade or degree, and year(s) attended for each school or program.

CDL / CLP Information

Provide all current, unexpired CDL or CLP information, including each state, license number, expiration date, class, and any restrictions.

Accidents

Traffic Convictions/Forfeitures

Employment Records

Employment References

Business Information

Bank Reference

Company References

List three references with whom you have had open account activities with for not less than 3 months (other carriers preferably)

Your Information & Agreement

Products & Materials

Work at the Quarry

Driving Opportunities

Products & Materials

Work at the Quarry

Driving Opportunities