Home
About
Services
Careers
Contact
Home
About
Services
Careers
Contact
Online Application
GENERAL INFORMATION
Betzen Trenching, Inc., is an Equal Opportunity Employer. It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin or other protected classification. Only information requested will be considered.
Name
*
First Name
Last Name
Phone
(###)
###
####
Address
*
How long have you lived at this address?
Who or what referred you to Betzen Trenching, Inc?
Position applying for
Laborer
Equipment Operator
Locator
Would you be able to perform the following without an accommodation: Standing for long hours, Lifting over 50lbs frequently, Bending frequently?
*
Yes
No
List any skills or experiences which you feel would especially qualify you for work with us?
Have you ever been convicted of a crime?
Yes
No
Are there any work area restrictions for your convictions?
*
Yes
No
If hired, when can you start work?
Betzen Trenching, Inc. is a Drug Free Workplace. As a condition of employment you may be required to submit to a substance abuse test and a physical examination. Are you willing to do so?
*
Yes
No
EDUCATION
List the last school you attended first.
School
*
Location
*
Years attended
*
Did you graduate?
*
Yes
No
Previous school
Location
Years attended
Did you graduate?
Yes
No
Other education
Did you graduate?
Yes
No
RECORD OF PREVIOUS EMPLOYMENT
List the last employer first, include military experience. (Please do not reference resume)
Employer
*
Employer address
*
Dates of employment
*
Title/duties
*
Reasons for leaving
*
Name of immediate supervisor
Does your current/last employer have a drug testing program that satisfies the requirements of the Department of Transportation?
Yes
No
If yes, when was the last time you were tested?
If you were tested within the last 6 months, what was the result?
Positive
Negative
Employer
Employer address
Dates of employment
Titles/duties
Reasons for leaving
Name of immediate supervisor
Employer
Employer address
Dates of employment
Titles/duties
Reasons for leaving
Name of immediate supervisor
DRIVERS LICENSE INFORMATION
State issued
*
Expiration date
Type
O
C
CDL
Group
A
B
C
Commercial license
Yes
No
Interstate
Yes
No
Intrastate
Yes
No
FMCSA Clearinghouse registered
Yes
No
Have you ever been denied a license, permit or privilege to operate a motor vehicle
*
Yes
No
Have you ever had a driver’s license, permit or driving privilege suspended or revoked
*
Yes
No
DRIVING EXPERIENCE
Class of equipment
Straight truck
Tractor and semi-trailer
Tractor - two trailers
Other
Dates of experience
ACCIDENT RECORD
List most recent accident first.
Date
Location
Nature of accident (head-on, rear-end, roll-over, etc.)
Were there fatalities and/or injuries? If so, please describe
Date
Location
Nature of accident (head-on, rear-end, roll-over, etc.)
Were there fatalities and/or injuries? If so, please describe
Date
Location
Nature of accident (head-on, rear-end, roll-over, etc.)
Were there fatalities and/or injuries? If so, please describe
BUSINESS & PERSONAL REFERENCES
List below three individuals who are not relatives and over the age of 21 whom have known you for 5 years or more.
Name
*
First Name
Last Name
Phone
*
(###)
###
####
Occupation
Address
Years known
Name
*
First Name
Last Name
Phone
*
(###)
###
####
Occupation
Address
Years known
Name
*
First Name
Last Name
Phone
*
(###)
###
####
Occupation
Address
Years known
EMERGENCY CONTACT
In case of an emergency, notify the following person
Relationship
Business phone
(###)
###
####
Home/cell phone
(###)
###
####
ACKNOWLEDGEMENT
By submitting this application I certify, on penalty of dismissal, that all answers and statements made by me pursuant to becoming employed by this company are true and correct. Any false information will result in immediate discharge. I further certify that I understand that as part of the procedure in processing this application there may include an investigative report whereby information , which may include, a thorough criminal history and credit check, as well as a personal interview with me and/or third parties, such as family members, business associates, former employers, financial sources, friends, neighbors, etc. This inquiry may include information as to my character, general reputation and personal characteristics, whichever may be applicable.
I understand and agree that if hired, employent is for no definite period, and I may,regardless of the date of payment of my wages and salary, be terminated at any time without previous notice.
I understand that the employee Polygraph Protection Act of 1988 permits polygraph testing of employees who are reasonably suspected of involvement in a workplace embezzlement, theft, or any illegal activity which may result in loss to the employer.
Confirm acknowledgement
*
I have read and accept the acknowledgement statement above
Thank you. Your application has been sent.
