Employment Application (CDL Driver)

This application is for CDL drivers. If you’re not applying to be a CDL driver, please use our general application.

To the Applicant: We appreciate your interest in Ron Meyer & Associates Excavating, Inc. and assure you that we are interested in your qualifications. A clear understanding of your background and work history will aid us in placing you in a position which, in our judgment, best meets your qualifications.

Ron Meyer & Associates Excavating, Inc. is an equal opportunity employer and will not unlawfully discriminate on the basis of race, color, religion, sex, age, disability status, national origin, protected veteran status, or any other characteristic protected by law.

Personal Information

Name(Required)

First Last

List your addresses of residency for the past 3 years.

Location(Required)

City State

Date From(Required)

Date To(Required)

Location (2)

City State

Date From

Date To

Location (3)

City State

Date From

Date To

Phone(Required)

Are you 18 years or older?(Required)

Yes

Are you legally qualified to work in the U.S.?(Required)

Yes

Have you been previously employed here?(Required)

Yes

What date(s) did you work here?(Required)

Have you filed an application here before?(Required)

Yes

What date(s) did you apply here?(Required)

Who referred you?

First Last

What method of transportation will you use to come to work?(Required)

Have you been convicted of a crime?(Required)

Yes

Where, when and nature of offense(s)(Required)

Employment Desired

Position(s) applied for(Required)

Kind of work sought(Required)

Full time

Part time

Other

Do you have any special training, skills, qualifications or other experiences that relate to the position(s) applied for?

Salary desired(Required)

Date available to start work(Required)

Education

Highest grade completed(Required)

Last school attended(Required)

School Location(Required)

City State

Employment Experience

All driver applicants to drive in interstate commerce must provide the following information on all employers for 3 years preceding the application date; without any gaps (additional space is provided to explain gaps in employment). Applicants to drive a commercial motor vehicle* in commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such vehicle. List employers in reverse order starting with the most recent.

Most Recent Employer

Company/Organization Name

Address

Street Address Address Line 2 City State ZIP Code

Date From

Date To

Reason for leaving

Contact Person

First Last

Contact Person's Phone

Position Held

Were you subject to the FMCSRs** while employed?

Yes

Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the controlled substance and alcohol testing requirements of 49 CFR part 40?

Yes

*Includes combination vehicles a GCWR or GCW of 26,001# or more, inclusive of a towed unit(s) with a GVWR or GVW over 10,000#, heavy straight vehicles having a GVWR or GVW of 26,001# or more, small vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

**The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle used on a highway in interstate commerce to transport passengers or property when the vehicle: (1) has a GVWR or GCWR or GVW or GCW of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is used to transport hazardous material in a quantity requiring placarding.

Next Most Recent Employer

Company/Organization Name (2)

Address

Street Address Address Line 2 City State ZIP Code

Date From

Date To

Reason for leaving

Contact Person

First Last

Contact Person's Phone

Position Held

Were you subject to the FMCSRs** while employed?

Yes

Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the controlled substance and alcohol testing requirements of 49 CFR part 40?

Yes

Next Most Recent Employer

Company/Organization Name (3)

Address

Street Address Address Line 2 City State ZIP Code

Date From

Date To

Reason for leaving

Contact Person

First Last

Contact Person's Phone

Position Held

Were you subject to the FMCSRs** while employed?

Yes

Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the controlled substance and alcohol testing requirements of 49 CFR part 40?

Yes

Next Most Recent Employer

Company/Organization Name (4)

Address

Street Address Address Line 2 City State ZIP Code

Date From

Date To

Reason for leaving

Contact Person

First Last

Contact Person's Phone

Position Held

Were you subject to the FMCSRs** while employed?

Yes

Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the controlled substance and alcohol testing requirements of 49 CFR part 40?

Yes

Reason for gap in employment (if any)

Date From

Date To

Reason for gap in employment (if any) (2)

Date From

Date To

Driver Experience/Qualification

List all unexpired CMV operator’s licenses or permits that have been issues to you.

Issuing State(Required)

State

License/Permit Number(Required)

Class/Endorsement(s)(Required)

Expiration Date(Required)

Issuing State (2)

State

License/Permit Number

Class/Endorsement(s)

Expiration Date

Have you ever been denied, have revoked or had suspended any license, permit or privilege to operate a motor vehicle?(Required)

Yes

Please provide the facts and circumstances of said occurrences.(Required)

Indicate the nature and extent of experience in the operation of motor vehicles. Specify which class of equipment and the equipment types you have driven along with the dates driven.

Class of Equipment(Required)

Pick-up Truck & Trailer

Straight Truck

Tractor & Semi-Trailer

Tractor & 2 Trailers

Motorcoach/Bus >8 pass.

Motorcoach/Bus >15 pass.

Other

Equipment Type(Required)

Date From(Required)

Date To(Required)

Equipment Type (2)

Date From

Date To

Equipment Type (3)

Date From

Date To

Equipment Type (4)

Date From

Date To

Equipment Type (5)

Date From

Date To

Equipment Type (6)

Date From

Date To

Equipment Type (7)

Date From

Date To

Motor Vehicle Accidents

List all motor vehicle accidents in which you were involved during the past 3 years.

Accident Date

Nature of Accident (Head-on, Rear-end, etc.)

Fatalities

Personal Injury

Hazardous Material Spill

Accident Date (2)

Nature of Accident (Head-on, Rear-end, etc.)

Fatalities

Personal Injury

Hazardous Material Spill

Accident Date (3)

Nature of Accident (Head-on, Rear-end, etc.)

Fatalities

Personal Injury

Hazardous Material Spill

Violations

List all violations of motor vehicle laws or ordinances (other than parking violations) of which you were convicted or forfeited bond or collateral during the past 3 years.

Location

City State

Date

Charge

Penalty

Location (2)

City State

Date

Charge

Penalty

Location (3)

City State

Date

Charge

Penalty

Employers must make accommodations to disabled applicants and employees where the accommodation does not impose an undue hardship on the employer. Under Michigan law, disabled employees and applicants may request an accommodation of their disability by notifying the employer in writing of the need for accommodation within 182 days of the date the disabled individual knew or reasonably should have known that an accommodation is needed. Failure to properly notify the firm may preclude any claim that the employer failed to accommodate the disabled individual.

References

(Do not include relatives or former employers)

Name

First Last

Relation

Phone

Years Known

Name (2)

First Last

Relation

Phone

Years Known

Name (3)

First Last

Relation

Phone

Years Known

Military Service Record

Have you had any experience in the Armed Forces of the United States or in a State National Guard?(Required)

Yes

What branch?(Required)

Rank at discharge(Required)

Date of discharge(Required)

Are you in the Reserves?(Required)

Yes

Date obligation ends(Required)

Special/technical training

Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?(Required)

Yes

Have you successfully completed the return-to-duty process per 49 CFR 40.25(b)(5) & (e)?(Required)

Yes

Documentation MUST BE PROVIDED before any safety-sensitive transportation function is performed.

State any additional information that you feel may be helpful to us in considering your application.

Authorization and Understanding

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. I authorize you to verify any of the information concerning my employment, education, credit or medical history with the appropriate individuals, companies, institutions or agencies, and I authorize them to release such information as you require, including my prior disciplinary employment record, without any obligation to give me written notice of such disclosure. I also authorize you to release any information requested by any of my prospective or subsequent employers without any obligation to give me written notice of such disclosure. I hereby release you and them from any liability whatsoever as a result of any such inquiries and disclosures. I agree that any false information in support of my application may subject me to discharge at any time during the period of my employment.

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CF 391.23(d) & (e). I understand that I have the right to review information provided by previous employers; have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

I agree that either party may terminate the employment relationship, with or without cause, at any time, and I further agree that this arrangement may only be altered in writing directed to me personally and signed by the president of the firm. I agree that I shall be bound by the other rules, policies, regulations and terms and conditions of employment of the firm as they are from time to time changed, and no additional obligations can be imposed on the Company except those which have been acknowledged in writing, by the president or his designated representatives. I hereby authorize the firm to deduct from each and every period of my pay any amounts necessary to offset any damages caused by me or the value of the property or money entrusted to me by or owed by me to the firm during the course of my employment.

I agree that any action or suit against the firm arising out my employment or termination of employment, including, but not limited to, claims arising under State or Federal civil rights statutes, must be brought within 180 days of the event giving rise to the claims or be forever barred. I waive any limitation periods to the contrary. I further agree that if I should bring in any non-statutory action or claim arising out of my employment against the firm, in which the firm prevails, I will pay to the firm any and all such costs incurred by the firm in defense of said claims or actions, including attorney fees. I further agree that my employment is conditional until such time as the results of my post-offer physical (if such physical is required) are known.

Request For Safety Performance History

I hereby authorize my prior employer(s) to release any and all information (specifically those required under 49 CFR 391.23 and 40.25) relating to my employment with them to Ron Meyer & Associates Excavating, Inc. I further release and hold harmless both my prior employer(s) and Ron Meyer & Associates Excavating, Inc. from any and all liability that may potentially result from the release and/or use of such information.

I authorize the request for Safety Performance History

We will email the request for Safety Performance History to the address you enter below.

Yes

Previous Employer's Email(Required)

Signature(Required)

Please type your name as your signature.

Phone

This field is for validation purposes and should be left unchanged.

Employment Application (CDL Driver)