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I acknowledge that I've read the above posting containing E-Verify. *

Position(s) you are applying for. Please choose at least one. *

Laborer
Operator
Driver (CDL)
Foreman
Office
Mechanic
Concrete

MM/DD/YYYY *

Available Start Date

MM/DD/YYYY *

Date of Birth

Desired Rate of Pay

Are You Looking For Full or Part Time Employment?

Full Time
Part Time

School Name

Did you graduate?

School City and State

Major or Degree

Are you currently employed? *

Current Employer Name *

Address

City

State

Zip

Contact Person

Phone Number

Position Held

Duties of Your Current Position

Employed From:

Employed Until:

Are you applying for a position that requires a CDL? *

Employer 1

Employer Name *

Address *

City *

State *

Zip *

Contact Person *

Phone Number *

Position Held *

Duties of Your Current Position *

Employed From: *

Employed Until: *

Employer 2

Employer Name *

Address *

City *

State *

Zip *

Contact Person *

Phone Number *

Position Held *

Duties of Your Current Position *

Employed From: *

Employed Until: *

Employer 3

Employer Name *

Address *

City *

State *

Zip *

Contact Person *

Phone Number *

Position Held *

Duties of Your Current Position *

Employed From: *

Employed Until: *

Was your job designated as a safety-sensitive function in any DOT regulated mode subject to the drug and alcohol testing requirements of 19 CFR Part 40? *

Were you subject to FMSCRs† while employed? *

* Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any sizevehicle used to transport hazardous materials in a quantity requiring placarding.

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

Other Experience and Qualifications

Show any trucking, transportation, or other experience that my help in your work for this company.

List courses and training other than shown elsewhere in this application.

List special equipment or technical materials you can work with (other than those already shown).

MVR Authorization & Disclosure

By checking the box below, I, the undersigned applicant/employee, grant AJ Pavement Construction the right to request, receive, and review my Motor Vehicle Record (MVR) from any relevant agency or bureau. This includes, but is not limited to, information regarding my driving history, license status, and traffic-related convictions or violations.

Acknowledge here

Legal Notice

This authorization is granted in accordance with Ohio Revised Code § 4501.27, which governs the release of driver and vehicle records, and 49 CFR Part 391, which requires motor carriers to evaluate driver qualifications under Federal Motor Carrier Safety Administration (FMCSA) regulations.

Scope & Duration

This authorization remains in effect throughout my employment or contractual relationship, unless I revoke it in writing. I understand revoking this authorization may affect my ability to drive on behalf of AJ Pavement Construction.

Confidentiality & Use

AJ Pavement Construction will use MVR data strictly for legitimate business purposes, including compliance with federal and state safety regulations, and will maintain the confidentiality of any records obtained. My MVR information will be disclosed only to individuals or entities with a legitimate need to access it, or as otherwise required by law.

Release of Liability

By authorizing this release, I waive and release AJ Pavement Construction from any liability arising from the lawful procurement and use of my MVR, consistent with applicable laws and regulations.

Name *

Date of Birth *

MM/DD/YYYY

Driver's License Number *

State *

Date of Expiration *

MM/DD/YYYY

Is your driver's license currently valid? *

Last 4 digits of your Social Security number *

Date *

MM/DD/YYYY

Signature

Thank you for your application!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Thank you for your application!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

AJ Pavement Construction

Employer 1

Employer 2

Employer 3

Accidents

Traffic Convictions/Forfeitures

Driver License(s) or permits held in the past 3 years?

DOT Medical Card

Driving Experience

Other Experience and Qualifications

MVR Authorization & Disclosure

Legal Notice

Scope & Duration

Confidentiality & Use

Release of Liability

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