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.