Contact Information

Driving Information

Driving Experience

Education

High School

College

Trade/Tech

Employment History

Please include all employment for the last 5 years

Employer #2

Employer #3

References

Please do not include relatives or former employers. (Professional or Trade)

Work Availability

If your application receives favorable consideration, when will you be available to begin work?

Authorization

Whether this application is received: via US mail, email, web portal or hand delivered I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation of this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by Erickson Asphalt Services, INC I understand that any employment is conditioned on a background check. I authorize Erickson Asphalt Services, INC to thoroughly investigate all statements contained in my application or resume and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to Erickson Asphalt Services INC without giving me prior notice of such disclosure. I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be “at will” and without fixed terms, and may be terminated at any time, with or without cause and without prior notice at the option of Erickson Asphalt Services INC or myself. No promises regarding employment have been made to me, and I understand that no such guarantee is binding upon Erickson Asphalt Services INC unless made in writing. If I am offered employment, I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by Erickson Asphalt Services INC and as permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to Erickson Asphalt Services INC the results of the examination, which results will remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug tests, and if I am hired a condition of employment will be that I abide by Erickson Asphalt Services INC Drug and Alcohol Policy. I further understand that filling out this form does not indicate there is a position open and does not obligate Erickson Asphalt Services INC to hire. If hired, I agree to abide by all company work rules, policies and procedures. Erickson Asphalt Services INC retains the right to revise its policies or procedures, in whole or part, at any time.

FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT

In accordance with the provisions of Section 604 (b) (2) (A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter I, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports are required by Sections 382.413, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations.