Driver Applicaton (Part 1)

SAUNDERS CONCRETE CO., INC.
CORTLAND READY MIX CO., INC.
CANASTOTA CONCRETE CO., INC.
W.F. SAUNDERS & SONS, INC.
We appreciate your interest in employment with our company. A Job Description for the position open is available for your review. Please answer
all questions as thoroughly as possible to all review of the information in relation to employment with our company. We are an Equal Opportunity
Employer. Employment‐related decisions are never based on race, gender, national origin, age, sexual orientation, marital status, labor affiliation,
disability, veteran status, job‐related felony conviction or any other protected status. Our company retains fully completed Employment
Application forms completed by individuals qualified for positions that may become for nine months after receipt.
Any applicant who falsifies information on this Employment Application will be disqualified from being hired. If an employee has been hired before
the falsification is discovered, the employee will be immediately terminated from employment on that basis. Any applicant who omits information
in this Employment Application may be disqualified for being hired. If an employee has been hired before the omission is discovered, the employee
may be terminated from employment on that basis.
Final consideration for this position requires the following if the box is checked:
Possession of a current, valid New York State Driver’ License, free from major infractions and acceptable to our insurance
carrier. Must possess this license for employment as a driver and as an occasional driver of company vehicles.
Possession of a current Commercial Drivers’License.
Passing a post‐offer/pre‐work drug and alcohol test.
Ability to have your own transportation to a work site.
PERSONAL INFORMATION
Name____________________________________________________________Social Security No._________________
Last
First
Middle
Address___________________________________________________________________________________________
No.
Street
City
State
Zip
Telephone Number(s) you can be reached at (____)________________________________________________________
Are you legally employable in the U.S.A.? Yes
No
Are you at least 18 years of age? Yes
No
Specific Position applying for:_____________________________________Expected rate of pay $________________/hr.
Are you applying for? full‐time
part‐time
Have you ever been employed by our company? Yes
Specific days and hours available:_________________________
No
Dates:______________Position:____________________
THE SAUNDERS COMPANIES
CDL DRIVER APPLICATION ADDENDUM
NAME (PRINT)
Date
The following information will be used only if directly related to the position for which you are applying.
YES
NO
1. Do you have at least two years licensed driving experience?
_____ _____
2. Do you have a valid driver's license?
_____ _____
3. Can you perform the job-related requirements of the specific job for which you are applying?
_____ _____
4. Are you willing and able to secure an NY Commercial Driver's License, if one is required?
_____ _____
5. Will you have reliable transportation to work?
_____ _____
6. Have you had any accidents in the last five years?
.
7. Have you been cited for any moving violations in the last three years?
_____ _____
8. Have you been convicted of any felony?
_____ _____
_____ _____
If you have answered "YES" to question 6, 7, 8 or 9, or "NO" to any of the other questions, please explain fully
below, indicating by number to which question you are responding.
BACKGROUND CHECK
APPLICANT QUESTIONAIRE REGARDING PREVIOUS DRUG AND ALCOHOL TESTING INFORMATION
APPLICANT: PLEASE CIRCLE YES OR NO IN RESPONSE TO THE FOLLOWING QUESTIONS AS REQUIRED BY U.S.
DEPARTMENT OF TRANSPORTATION REGULATONS (49 CFR PART 40). IN THE PAST TWO YEARS:
1. Have you had any DOT required alcohol tests with a result of 0.04 or higher alcohol concentration?
YES / NO
2. Have you had any verified positive DOT required drug tests?
YES / NO
3. Have you refused to be tested (including having a verified adulterated or substituted drug test result)?
YES / NO
4. Have you had any other violation of a DOT agency drug or alcohol testing regulation?
YES / NO
5. Were there any situations in which you tested positive on a pre-employment test for a DOT
employer that did not hire you?
YES / NO
6. Were there any situations in which you refused to submit (including any adulterated or substituted
findings) to a pre-employment test for a DOT employer that did not hire you?
YES / NO
I certify that my responses to the above questions are true:
Applicant's Signature:
Date:
Printed Name:
SSN:
CDL DRIVER APPLICATION ADDENDUM
CONSENT FOR A RELEASE OF DRUG AND ALCOHOL TESTING INFORMATION AND
TREATMENT RECORDS
PLEASE PRINT
Applicant
Name:
SSN:
APPLICANT: IF YOU WERE EMPLOYED BY A DOT REGULATED EMPLOYER DURING THE LAST TWOYEARS AND
PERFORMED A SAFETY SENSITIVE FUNCTION FOR THAT EMPLOYER, PLEASE PROVIDETHE NAME OF THAT
EMPLOYER, A COMPLETE MAILING ADDRESS, AND PHONE NUMBER STARTINGWITH THE AREA CODE. START WITH
THE MOST RECENT EMPLOYER FIRST
PREVIOUS EMPLOYER:
FROM:
Address:
State:
City:
Zip Code:
PREVIOUS EMPLOYER:
Zip Code:
Zip Code:
TO:
City:
Zip Code:
PREVIOUS EMPLOYER:
Phone Number:
FROM:
Address:
TO:
City:
Zip Code:
PREVIOUS EMPLOYER:
Phone Number:
FROM:
Address:
TO:
City:
Zip Code:
PREVIOUS EMPLOYER:
Phone Number:
FROM:
Address:
State:
Phone Number:
FROM:
Address:
State:
TO:
City:
PREVIOUS EMPLOYER:
State:
Phone Number:
FROM:
Address:
State:
TO:
City:
PREVIOUS EMPLOYER:
State:
Phone Number:
FROM:
Address:
State:
TO:
TO:
City:
Zip Code:
Phone Number:
PREVIOUS EMPLOYER:
FROM:
Address:
State:
City:
Zip Code:
PREVIOUS EMPLOYER:
TO:
City:
Zip Code:
PREVIOUS EMPLOYER:
Phone Number:
FROM:
Address:
State:
Phone Number:
FROM:
Address:
State:
TO:
TO:
City:
Zip Code:
Phone Number:
I,(print name) _____________________________________ authorize my above listed previous
employers to release to The Saunders Companies, 5126 South Onondaga Rd., Nedrow,NY 13120, phone (315)469-3217
or fax (315)469-3940 any verified positive drug test results, any alcohol test result of 0.04 or greater, any refusal to test
(including verified adulterated or substituted drug test results), and information on any required substance abuse
professional evaluation, determination of need for assitance and complicance with these recommandations for the
preceding two years. I request these records be released immediately. This authorization is valid unitil withdrawn be me
in writing.
Dated this ______________________ of _________________, __________
(Today's Date)
(Month)
(Year)
Name of Applicant: ______________________________________ Date: ___________________
Signature of Applicant: _______________________________________ Date: ___________________
W.F. Saunders and Sons is an equal opportunity employer
CDL DRIVER APPLICATION ADDENDUM
REQUEST FOR DRIVER INFORMATION
PRINT ALL INFORMATION LEGIBLY
This document must be fully completed for The Saunders Companies to obtain a Motor Vehicle driver Report.
DRIVER INFORMATION
NAME:
LAST
FIRST
INITIAL
ADDRESS
CITY
STATE
ZIP CODE
TELEPHONE NUMBER(S) YOU CAN BE REACHED AT
DRIVER LICENSE INFORMATION
Driver's License Number
State
Social Security Number
Date of Birth
List all States in which you have had an Operator's License
DRIVER RELEASE
I, ________________________________________, hereby Authorize W.F. Saunders and Sons, Fletcher
Gravel, Saunders Concrete Company, Cortland Ready-Mix, Canastota Concrete Company, and/or Dorwin
Springs Building Supply to request a copy of my Motor Vehicle Driver's Report.
In addition, should my apllication be accepted for employment and/or upon my becoming an employee for W.
F. Saunders and Sons, Fletcher Gravel, Saunders Concrete Company, Cortland Ready-Mix, Canastota Concrete
Company, and/or Dorwin Springs Building Supply, I further authorize any/all additional requests for my Motor
Vehicle Record be submitted and reviewed as needed for the sole purpose of my continued evaluation and
eligibility standards under the State and Federal regulatory compliance standards.
Signature of Driver__________________________________ Date _____________________
SS#_______________ Date of Birth ___________
Driver License # ______________
Ordered By and for Future Employment Purposes ONLY with
W.F. Saunders & Sons
Human Resources Department
5126 South Onondaga Road
Nedrow, NY 13120
CDL DRIVER APPLICATION ADDENDUM
Please provide us with traffic violations and accident information for the last five years. Any deletions or
omissions will be sufficient reason for denial of your application.
TRAFFIC VIOLATIONS
DATE
STATE
TYPE OF VIOLATION
POINTS OR PENALTY
ACCIDENT INFORMATION
DATE
PERSONAL
OR
COMMERCIAL
NATURE OF ACCIDENT
AT-FAULT
NOT AT-FAULT
INJURIES
FATALTY
DETAILS:
DETAILS:
DETAILS:
I certify that my responses to the above questions are true:
Applicant's Signature: _______________________________________ Date: __________________________
Printed Name: _____________________________________________ SSN: ___________________________
COST