Employment Application

M3 Contracting is an Equal Opportunity Employer.  No question on this application is intented to be discriminatory under any application Federal, State or Local Fair Employment Practices Law.

Personal Information

Date*
First Name*
Middle Name
Last Name*
Address
City*
State*
Zip*
Home Phone*
Cell Phone
Email*
Have you ever been involuntarily terminated or requested to resign?* Yes    No
If hired, can you provide verification of your legal right to work in the United States?* Yes    No
Are you 18 years of age or over?* Yes    No
If required for the position, do you have a valid driver's license?* Yes    No
If hired, can you travel if a job requires it?* Yes    No
Have you ever filed an application and/or been previously employed with us?* Yes    No
Do you have friends or relatives working for our company?* Yes    No
If yes, Name and relationship
Emergency Contact Name*
Emergency Contact Phone*

Employment Interests

Position Desired*
Date Available*
Salary Desired*
Would you be willing to work overtime?* Yes    No
Type of employment
desired*
Regular
Full Time
Temporary
Part Time
Days and hours available for work*

Education

School Level Name and Location of School Course of Study Select last grade completed Did you graduate?
High School 1    2    3    4    Yes    No
College/University 1    2    3    4    Yes    No
Post Graduate 1    2    3    4    Yes    No
Business/Trade Technical 1    2    3    4    Yes    No

Skills - If applicable for position for which you are applying

Describe any specialized training, apprenticeship, skills, and job related military training
Describe mechanical background that may relate to the job desired
Do you read blueprints? Yes    No
Do you read schematics? Yes    No

Employment Information - Start with current or most Recent Employer

Company Name 1
Phone
Address
City
State
Zip
Job Title(s)
Duties
Employed From
Starting & Ending Pay
Reason for leaving
Supervisor Name
May we contact this employer? Yes    No
Company Name 2
Phone
Address
City
State
Zip
Job Title(s)
Duties
Employed From
Starting & Ending Pay
Reason for leaving
Supervisor Name
May we contact this employer? Yes    No
 
Company Name 3
Phone
Address
City
State
Zip
Job Title(s)
Duties
Employed From
Starting & Ending Pay
Reason for leaving
Supervisor Name
May we contact this employer? Yes    No
Company Name 4
Phone
Address
City
State
Zip
Job Title(s)
Duties
Employed From
Starting & Ending Pay
Reason for leaving
Supervisor Name
May we contact this employer? Yes    No

References

1. Name     Phone 
2. Name     Phone 
3. Name     Phone 

Miscellaneous

State any additional information you feel may be helpful to us in considering your application.
Do not answer this question unless you have been informed about the requirements of the job for which you are applying.


Driver's Addendum to Application Form pursuant to Federal Motor Carrier Safety Regulation 49 C.F.R. §391.21

COMMERCIAL DRIVER'S LICENSE: List all Commercial Driver Licenses or Permits held in the past 3 years.
StateLicense NumberTypeExpiration Date

Date of Birth
Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes    No
Has any license, permit or privilege ever been suspended or revoked? Yes    No
Were you subject to the Federal Motor Carrier Safety Regulations while Employed? Yes    No
Was your job designated as a safety-sensitive function in any DOT-regulation mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? Yes    No
If the answer to the above questions is yes, please provide specific details (including dates):

ACCIDENT RECORD: List all motor vehicle accidents in which you were involved during the 3 years (attach sheet if more space is required). If none, write none.
DateNature of Accident
(Head-On, Rear-End, Upset, etc.)
Fatalities/InjuriesHazardousMaterial Spill

TRAFFIC CONVICTIONS AND FORFEITURES: List all motor vehicle convictions and forfeitures during the past 3 years (other than parking violations). If none, write none.
LocationDateChargePenalty

DRIVING EXPERIENCE
Class of EquipmentEquipment TypeDates (From-To)Approximate # of Total Miles
Other:
List states operated in for the last 5 years:
Which safe driving awards do you hold and from whom?

ADDRESS: Please list all residential Current and Past Addresses for prior three (3) years. Please include dates (From-To)
StreetCityStateZip CodeDates (From-To)


Acknoweldgement

I authorize any person, school, current employer (except as expressly noted), past employer(s), and organizations named in this application form (and accompanying resume or documentation, if any) to M3 Contracting with relevant information and opinion, personal or otherwise, that may be useful in asking a hiring decision.  I release all parties from all liability for any damage that may result from furnishing information and opinion to you.
In consideration of employment, I agree to obey the rules and standards of M3 Contracting.  I understand that noting contained in this application or in the interview process is intended to create a contract between M3 Contracting and myself for with employment or providing of any benefits.  I agree that my employment is at-will and the terms of employment may be changed with or without cause, with or without notice, including but not limited to termination, demotion, promotion, transfer, compensation, benefits, duties and location of work at any time, for any reason, at the option of myself or M3 Contracting.  This constitutes my entire agreement with M3 Contracting with regard to the length of my employment.
I understand that as a condition of employment I may be required to take a post-offer/pre-employment drug test.  I further understand that at any time during my employment, I may be required to take a physical examination which may include an alcohol and drug test if management reasonable suspects a condition exists that will prevent me from preforming my job in a manner that does not endanger my own health or the safety and health of others.  I authorize all providers of health care who examine me to disclose to M3 Contracting, or its agents, all medical information revealed during such examinations.  I further authorize M3 Contracting to disclose such information to any other persons if at any time my medical condition is put at issue in any proceeding by myself or others.  In the event that I have a disability that will affect my ability to take the test, I will so inform M3 Contracting so that a reasonable accommodation can be made.  M3 Contracting reserves the right to require medical documentation concerning the need for accommodation.
I understand that all offers of employment are conditioned upon my providing satisfactory documentary proof of my identity and legal right to live and work in the United Sates.
I hereby acknowledge that I have read the above statements and understand them.  I certify that, I, the applicant, have personally completed this application.  I declare under penalty of perjury that the facts contained in the application (or any resume, or other documents submitted) are true and complete to the best of my knowledge.  I understand that nay misrepresentations or omissions will disqualify me from further consideration of employment, and will be justification for my dismissal from employment, if discovered at a later date.
I understand that the information I provided regarding my current and/or previous employer(s) may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I also understand that I have the right to (1) review any information provided by my previous employer(s); (2) have any errors in the information supplied by my previous employer(s) corrected and resubmitted; and (3) provide a rebuttal statement to the information I still believe is erroneous, if my previous employer(s) and I cannot agree on the accuracy of the information.
Electronic Signature*
Date*