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Truck Driver / Laborer
Diesel Mechanic - Scottdale

Personal Information

Full Name*

(As displayed on your driver's license)

First Middle Last

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Street Address Address Line 2 City State ZIP Code

Primary Phone*

Alternate Phone

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Social Security #*

Drivers License #*

Drivers License Expiration Date*

CDL*

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CDL Class*

Employment History

Please include information about last three jobs.

Resume

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Employment History*

Job Title	Company Name	Address	Job Description	Start Date	End Date

Employment History

Job Title	Company Name	Address	Job Description	Start Date	End Date

Employment History

Job Title	Company Name	Address	Job Description	Start Date	End Date

Additional Information

How did you learn of this job opportunity?*

Name of Referral

Do you hereby authorize the release of the following information?*
* All applicants must consent to a Motor Vehicle (MVR) and Criminal Background check to be considered for employment with Green Acres Contracting Company, Inc.

Request for Background Check*

Yes
No

Request for Motor Vehicle Record*

Yes
No

Limited Query FMCSA Drug and Alcohol Clearing House*

Yes
No

will consent to Green Acres Contracting Co., Inc. to conduct a limited query of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I understand that if the limited query conducted by Green Acres Contracting Co., Inc. indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Green Acres Contracting Co., Inc. without first obtaining additional specific consent from me.I further understand that if I refuse to provide consent for Green Acres Contracting Co., Inc. to conduct a limited query of the Clearinghouse, Green Acres Contracting Co., Inc. must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.

Voluntary Survey

Governmental agencies at times require periodic reports on the sex, ethnicity, veteran status and other protected status of employees. This data is for statistical analysis with respect to the success of Green Acres Contracting Co., Inc. Equal Opportunity Policy. Submission of this information is voluntary. Inclusion or exclusion of any data will not effect any employment decision.

Sex

Male
Female

Veteran

Yes
No

Ethnic Origin

Name

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Green Acres Contracting Co. Job Application

Personal Information

Employment History

Additional Information

Voluntary Survey