Hotshot Driver (DOT Position)

Location: Dickinson, North Dakota
Date Posted: 08-03-2018
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Acknowledgements of Terms and Conditions of Application
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge.  I further certify that I, the undersigned applicant, have personally completed this application.   I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
 
I hereby authorize “the company” to thoroughly investigate my references, work record, education, DMV record, and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. I will not bring any legal claims or actions against my current or former employers due to their responses to any job reference request. 
 
I understand that agreement to binding arbitration of all employment-related disputes with “the company” is a condition of new employment by “the company”, and that if I am hired in a non-union position, I will be required to sign a Mutual Agreement to Arbitrate Claims covering all employment-related disputes, and that if I am hired in a union position, the applicable collective bargaining agreement will contain a grievance and arbitration procedure covering all employment-related disputes. Copies of the Mutual Agreement to Arbitrate Claims and all collective bargaining agreements to which “the company” is signatory describe the applicable arbitration procedures and are available from the Human Resources Department upon request.
 
THIS AGREEMENT IS A WAIVER OF ALL RIGHTS TO CIVIL COURT ACTIONS FOR A CLAIM SUBJECT TO ARBITRATION. ONLY THE ARBITRATOR, NOT A JUDGE OR JURY, WILL DECIDE THE CLAIM OR DISPUTE.
 
I understand that nothing contained in the application, or conveyed during any interview which may be granted is intended to create an employment agreement. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without advance notice and without liability, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the Company unless made in writing and signed by me and the Company's President, CEO.
 
I understand that a job offer will be contingent on passing a job related physical examination, drug testing, and background investigation.
 
I further understand that the completion of an application with “the company” is a preliminary step to employment.  It does not obligate “the company” to offer employment to me, or for me to accept employment.  
 
I understand that this Application will remain active for 30 days.  If I wish to be considered for employment beyond this period, I will have to complete another application.
 
My signature below certifies that I agree to be bound by the terms and conditions stated in this application, which contains all the understandings between “the company” and me concerning the topics addressed herein, and supersedes any prior inconsistent understandings between “the company” and me on such issues.

General Information:


 

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Affiliated Companies: Cruz Construction, Inc. / Cruz Energy Services, LLC / Cruz Marine, LLC / Alaska Interstate Construction, LLC / Alaska Aggregate Products, LLC

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If yes, please give the name and relationship.

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Yes
No

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Website, Craigslist, Friend, Radio, etc.

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Yes
No
With reasonable accommodation if need be

Background Information:


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Yes
No

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Professional Experience:


 
List any additional courses and relevant training completed.

 

 
Please include, name, phone number, and email address.

 

 

 

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Yes
No

 

* Work History (Please list your employers for the last 10 years beginning with your most recent). #1


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* Work History (Please list your employers for the last 10 years beginning with your most recent). #2


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* Work History (Please list your employers for the last 10 years beginning with your most recent). #3


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Work History (Please list your employers for the last 10 years beginning with your most recent). #4


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Work History (Please list your employers for the last 10 years beginning with your most recent). #5


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Work History (Please list your employers for the last 10 years beginning with your most recent). #6


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Enter N/A for any unused fields. If you require additional Work History space please contact Human Resources at hr@cruzconstruct.com

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Signature:


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This is your electronic signature

The following questions are to ensure EEOC compliance and are strictly voluntary. We maintain this data for EEOC inquiries and to assist in any discrimination investigations by the federal, state and local governments.
 

 

Invitation to Self-Identify as a Veteran

This employer is a Government contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:

  • A "disabled veteran" is one of the following:
    • a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
    • a person who was discharged or released from active duty because of a service-connected disability.
  • A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service.
  • An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
  • An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below.

As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2020
Voluntary Self-Identification of Disability

Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

  • Blindness
  • Deafness
  • Cancer
  • Diabetes
  • Epilepsy
  • Autism
  • Cerebral palsy
  • HIV/AIDS
  • Schizophrenia
  • Muscular dystrophy
  • Bipolar disorder
  • Major depression
  • Multiple sclerosis (MS)
  • Missing limbs or partially missing limbs
  • Post-traumatic stress disorder (PTSD)
  • Obsessive compulsive disorder
  • Impairments requiring the use of a wheelchair
  • Intellectual disability (previously called mental retardation)

Please check one of the boxes below:

Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

iSection 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

This additional information is required when applying for DOT positions.  

 

Driving History:


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Work History #1-Yes, subject to FMCSA Standards
Work History #1-No
Work History #2-Yes, subject to FMCSA Standards
Work History #2-No
Work History #3-Yes, subject to FMCSA Standards
Work History #3-No
Work History #4-Yes, subject to FMCSA Standards
Work History #4-No
Work History #5-Yes, subject to FMCSA Standards
Work History #5-No
Work History #6-Yes, subject to FMCSA Standards
Work History #6-No
Please select Yes or No for each of the corresponding Work Histories listed above.

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Work History #1-Yes, this job was a Safety Sensitive Function
Work History #1-No
Work History #2-Yes, this job was a Safety Sensitive Function
Work History #2-No
Work History #3-Yes, this job was a Safety Sensitive Function
Work History #3-No
Work History #4-Yes, this job was a Safety Sensitive Function
Work History #4-No
Work History #5-Yes, this job was a Safety Sensitive Function
Work History #5-No
Work History #6-Yes, this job was a Safety Sensitive Function
Work History #6-No
Please select Yes or No for each of the corresponding Work Histories listed above.

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Please list: State, License Number, Class, and Expiration Date For Example: Minnesota, XXXXXXX, Class A, 06/20/2025

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Please list: Date, Type of accident, City, State, if there were fatalities/injuries, and if it was Hazmat related. For Example: 4/5/2015, Fender Bender, Boulder, CO, None, Not Hazmat Related

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Please list: Date, Location, Charge, and Penalty. For Example: 6/12/2014, Bozeman, MT, Speeding 20 mph over limit, Speeding Ticket

DOT Section Signature:


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This is your electronic signature

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