Join our team_If you’d like to apply to join the S&M Paving team, please complete and submit the application below.S&M PAVINGEmployment ApplicationCompanyStreet Address City State / Province / Region ZIP / Postal Code Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code How long have you lived there?*Please enter a number less than or equal to 100.Date of Birth* MM slash DD slash YYYY Phone*Email* Social Security No.*Previous Three Years ResidencyPrevious Address #1 Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code # of YearsPrevious Address #2 Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code # of YearsPrevious Address #3 Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code # of YearsLicense InformationSection 383.21 FMCSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license". I certify that I do not have more than one motor vehicle license, the information for which is listed below.State*License No.*Type*Expiration Date* MM slash DD slash YYYY Driving ExperienceClass of Equipment Straight Truck Tractor and Semi-Trailer Tractor - Two Trailers OtherType of Equipment (Straight Truck)Dates (From-To)Approx. No. of MilesType of Equipment (Tractor and Semi-trailer)Dates (From-To)Approx. No. of MilesType of Equipment (Tractor - Two Trailers)Dates (From-To)Approx. No. of MilesType of Equipment (Other)Dates (From-To)Approx. No. of MilesAccident RecordPlease list any accidents you've had in the past three years. If more space is needed, use the upload button to attach a document.FileMax. file size: 256 MB.Nature of Accident #1Date of Incident #1 MM slash DD slash YYYY No. of FatalitiesNo. of InjuriesChemical Spills?YesNoNature of Accident #2Date of Incident #2 MM slash DD slash YYYY No. of FatalitiesNo. of InjuriesChemical Spills?YesNoNature of Accident #3Date of Incident #3 MM slash DD slash YYYY No. of FatalitiesNo. of InjuriesChemical Spills?YesNoTraffic Convictions and ForfeituresFor the past 3 years (other than parking violations). If more space is needed, use the upload button to attach a document.FileMax. file size: 256 MB.Violation #1Date Convicted MM slash DD slash YYYY State of ViolationPenaltyViolation #2Date Convicted MM slash DD slash YYYY State of ViolationPenaltyViolation #3Date Convicted MM slash DD slash YYYY State of ViolationPenaltyHave you ever been denied a license, permit or privilege to operate a motor vehicle?*NoYesIf yes, please explain:Has any license, permit or privilege ever been suspended or revoked?*NoYesIf yes, please explain:Employment RecordApplicants that desire to drive in Intrastate/Interstate commerce must provide the following information on all employers during the previous three years. You must give the same information for all employers you have driven a commercial motor vehicle for the seven years prior to the initial three years (total of ten years employment record). Must list the complete mailing address: street number and name, city, state and zip code.Last Employer: NamePhoneAddress Street Address City State / Province / Region ZIP / Postal Code Position HeldCurrently Still Employed?NoYesFROM Date MM slash DD slash YYYY TO Date MM slash DD slash YYYY SalaryReason for LeavingWere you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer? Yes NoWas the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40? Yes NoAny gaps in employment and/or unemployment must be explained.Previous Employer NamePhoneAddress Street Address City State / Province / Region ZIP / Postal Code Position HeldCurrently Still Employed?NoYesFROM Date MM slash DD slash YYYY TO Date MM slash DD slash YYYY SalaryReason for LeavingWere you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer? Yes NoWas the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40? Yes NoAny gaps in employment and/or unemployment must be explained.Previous Employer NamePhoneAddress Street Address City State / Province / Region ZIP / Postal Code Position HeldCurrently Still Employed?NoYesFROM Date MM slash DD slash YYYY TO Date MM slash DD slash YYYY SalaryReason for LeavingWere you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer? Yes NoWas the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40? Yes NoAny gaps in employment and/or unemployment must be explained.To Be Read and Signed by ApplicantI authorize you to make sure investigations and inquiries to my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company. "I understand that information I provide regarding current and/or previous employers 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 understand that I have the right to: ~ Review information provided by current/previous employers; ~ Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and ~ Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information." This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.Today's Date* MM slash DD slash YYYY Electronic Signature* First Name Last Name CAPTCHA
