Driver/Operator/Laborer Employment Application

    If resided at above address for less than 3 years, please complete below until you complete 3 years of residency history:

    CDL Section

    NOTE: Information required in accordance to FMCSA 391.21(b)(2)

    Have you ever received a denial, revocation, or suspension of any license, permit or privilege to operate a motor vehicle?

    Have you been involved in any motor vehicle accidents during the past 3 years?

    If yes, please complete the following in detail and provide any additional information necessary

    Accident 1

    Accident 2

    Have you ever been convicted of a misdemeanor or felony?

    NOTE: A conviction will not necessarily disqualify you from employment. Each conviction will be judged on its own merits with respect to time, circumstance and seriousness.

    Have you been convicted or forfeited bond or collateral for a motor vehicle violation (other than parking violations) during the past 3 years?

    If yes, please complete the following in detail and provide any additional information necessary:

    Violation 1

    Violation 2

    Employment History

    Please list employment history beginning with the most current employment. A minimum of 3 years history required.

    Employer 1

    Employer 2

    Employer 3

    Employer 4


    High School


    Trade/Specialized School



    Reference 1

    Reference 2

    Job Requirements


    Please read the following paragraphs carefully. Submitting this form indicates your understanding and acceptance of each of these paragraphs.

    1. I authorize any of the personal or organizations referenced in this application to provide JM Construction Inc.
      with information concerning any previous employment, education, or any other information they
      might have, personal or otherwise, with regard to any of the subjects covered by this application, and
      I release all such parties from all liability for any damage which may result from furnishing such
      information to JM Construction Inc.
    2. I understand the information that I have provided is in accordance with section FMCSA 391.21 paragraph (b)(10) and
      that my prior employers may be contacted for the purpose of investigating my saftey performance history information
      as required by paragraphs (d) and (e) of 391.23. I understand that I have rights in accordance to 391.23(i) regarding
      information obtained from prior employers. (APPLICABLE TO CDL APPLICANTS)
    3. I consent to a physical examination, which includes a drug test, either prior to commencement of
      employment or after I have become employed, as deemed necessary by the JM Construction Inc.
    4. I consent to a criminal background check prior to employment with JM Construction Inc.
    5. I hereby declare the information provided by me in this application is true and complete, and I
      understand that falsification and/or omissions of this information is grounds for refusal to hire or, if I have
      been hired, for termination.
    6. I further acknowledge that if I am employed by JM Construction Inc., my employment will be at will,
      and may be terminated with or without cause, and with or without notice at any time, by me or by JM Construction Inc.