Address:
Address:
City:
State:
Zip Code:
E-mail:
Phone number where you can be contacted:
Home Phone:
Cell Phone:
Are you at least 18 years of age? YES
NO
Will
Visa or immigration status prevent lawful employment?
YES
NO
Have you ever worked for AA Asphalting before? YES
NO
If YES, please describe, including dates of
employment, rate of pay, position, and your reason for
leaving.
Were you referred by someone? YES
NO
If yes, who?
EMPLOYMENT
HISTORY
All Applicants must
provide the following information for current or
previous employers during the preceding 3 years.
Applicants to drive a
commercial motor vehicle in intrastate or interstate
commerce (lead, foreman, and driver positions)
must provide an additional 7 years of employment
information for those employers of whom the applicant
operated such vehicle.
Are you currently
employed? YES
NO
If NO, what was your last date of employment?
mon
JAN
FEB
MAR
APR
MAY
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1991
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1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
year
NOTE: List employers in reverse order starting with
your current or most recent.
We will not contact your current employer without your
permission.
Is this your
current employer? YES
NO
If YES, may we contact this employer? YES
NO
Dates:
From:
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
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1990
1991
1992
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1994
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1997
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2000
2002
2003
2004
2005
2006
2007
2008
year
To:
mon
JAN
FEB
MAR
APR
MAY
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AUG
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OCT
NOV
DEC
day
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1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2002
2003
2004
2005
2006
2007
2008
year
Employer:
Address:
City:
St.
Zip:
Contact:
Telephone:
Duties:
Position Held:
Wage:
Reason for leaving:
CLICK
HERE IF DONE ENTERING EMPLOYERS
Dates:
From:
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
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30
31
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2002
2003
2004
2005
2006
2007
2008
year
To:
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
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29
30
31
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2002
2003
2004
2005
2006
2007
2008
year
Employer:
Address:
City:
St.
Zip:
Contact:
Telephone:
Duties:
Position Held:
Wage:
Reason for leaving:
CLICK
HERE IF DONE ENTERING EMPLOYERS
Dates:
From:
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
5
6
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9
10
11
12
13
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26
27
29
30
31
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2002
2003
2004
2005
2006
2007
2008
year
To:
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
5
6
7
8
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10
11
12
13
14
15
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17
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21
22
23
24
25
26
27
29
30
31
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
year
Employer:
Address:
City:
St.
Zip:
Contact:
Telephone:
Duties:
Position Held:
Wage:
Reason for leaving:
CLICK
HERE IF DONE ENTERING EMPLOYERS
Dates:
From:
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
5
6
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8
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10
11
12
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14
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17
18
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22
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24
25
26
27
29
30
31
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
year
To:
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
5
6
7
8
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10
11
12
13
14
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22
23
24
25
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27
29
30
31
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
year
Employer:
Address:
City:
St.
Zip:
Contact:
Telephone:
Duties:
Position Held:
Wage:
Reason for leaving:
If you still need
more room, please use the following fill-in form and be
sure to include the same information as above:
SKILLS
TRAINING & QUALIFICATION
Indicate your level of
education:
Grade
School 1 2
3 4
5 6
7 8
High School: 9
10 11
12
Technical or Trade School: 1
2
3
4
College: 1 2
3 4
Last School Attended:
List any special
training programs you have participated in:
Summarize your
special skills or qualifications as they pertain to the
job you are applying for:
What types
(include makes/models) of construction equipment can you
operate or repair?
If the position you are applying for involves the
driving/operation of vehicles or equipment, do you have
a valid license?
YES
NO
If Yes, provide license
#
State:
Expires on:
CDL
DRIVERS ONLY
Applicants
to drive a commercial motor vehicle in intrastate or
interstate commerce (lead, foreman, and driver
positions) must complete this section.
Explain
any gaps in employment during the past three years
Dates
From:
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
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6
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8
9
10
11
12
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14
15
16
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19
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22
23
24
25
26
27
29
30
31
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
year
To
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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24
25
26
27
29
30
31
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
year
Explain:
Dates From:
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
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22
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24
25
26
27
29
30
31
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2007
2008
year
To
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
29
30
31
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2007
2008
year
Explain:
Dates From:
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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20
21
22
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24
25
26
27
29
30
31
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
year
To
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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24
25
26
27
29
30
31
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
year
Explain:
Dates From:
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
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18
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21
22
23
24
25
26
27
29
30
31
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
year
To
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
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24
25
26
27
29
30
31
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
year
Explain:
Provide living addresses for the past three years:
Street
City
State &
ZIP
How Long?
Street
City
State &
ZIP
How Long?
Have you had a
motor vehicle accident within the past 3 years?
YES
NO
If
yes, please explain each incident. Include the
date, the nature (head-on, rear-end, etc), indicate if
there were any injuries or fatalities:
Have you had a
traffic conviction (other than parking violations)
within the past 3 years?
YES
NO
If
yes, please explain each incident. Include the
date, the location, charge of conviction, and penalty:
Have you ever been
denied a license, permit, or privilege to operate a
motor vehicle?
YES
NO
Have you ever had your license, permit, or privilege
suspended or revoked?
YES
NO
If the answer to either question above is YES, please
provide details:
Please indicate
your driving experience
Equipment Class
Equipment Type
Dates
Mileage
Straight
Truck
Van Tank Flat
Other
From
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
29
30
31
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
year
To
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
29
30
31
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
year
in thousands
Tractor&Semi-Trailer
Van Tank Flat
Other
From
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
29
30
31
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
year
To:
mon
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
29
30
31
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
year
in thousands
Tractor-2
Trailers
Van Tank Flat
Other
From