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*Last Name
 *First Name
 Middle
*Current Address
 Yrs at Residence:
  
*City
 *State
 *Zip
*Phone
 *Email Address
  
Position Applied For:
 How did you learn about us?
  

If you are under 18 years of age, can you provide required proof of your eligibility to work?
 Yes No

Have you ever filed an application with us before?  Yes No
If yes, give date:

Have you ever been employed with us before?  Yes No
If yes, give date:

Are you currently employed?  Yes No

May we contact your current employer?  Yes No

Are you legally eligible to work in the United States? (Proof of eligibility will be required upon employment.)  Yes No

On what date would you be available for work?

Can you travel if a job requires it?  Yes No

Have you been convicted of a felony or any criminal offense within the last 7 years?
 Yes No
(Conviction will not necessarily disqualify an applicant from employment.)
If yes, please explain:

Have you ever had any job related training in the United States Military?
 Yes No
If yes, please explain:

Education School Name & Location Years Completed Diploma and/or Degree Course of study
High School
Business or Vocational School
College

In the box below, describe any specialized training, apprenticeship, skill or extra curricular activities.
 In the box below, describe any honors you have received:
 In the box below, state any additional information you feel may be helpful to us in considering your application:
     

List Professional, trade, business, or civic activities and offices held:

Driver License Information

State License Number Type Expiration Date
Class of Equipment Type of Equipment Start Date End Date Approx. Number of Miles

 

Equipment Experience

Type of Equipment: Hours of Experience: Installation of:
Finish Cat
Backhoe
Trencher
Vibrator Plow
Skid Loader
Boring Equipment

Please list types of Boring Equipment:

Please list any other equipment you have operated (Trucks, Turk Tractors, Semi Trailers, Full Trailers, Pole Trailers, 1 ton Trucks, Aerial Truck Devices, etc.):


CDL Driver Information

Residence (last 3 years):

Street Address: Month/Year:
City: State: Zip:


Street Address: Month/Year:
City: State: Zip:


Street Address: Month/Year:
City: State: Zip:

Violations (convictions for the last 3 years):

Date: Type of Violation:
Date: Type of Violation:
Date: Type of Violation:
Date: Type of Violation:
Date: Type of Violation:
Date: Type of Violation:
Date: Type of Violation:

Accident Record for Past 3 Years or More:

Dates Nature of Accident (Head on, Rear End, Etc.) Fatalities Injuries

Have you ever been denied a license, permit or privilage to operate a motor vehicle?  Yes No

Has any license, permit, privilege ever been suspended or removed?  Yes No

If you answered yes to the above questions, please give details in box:

Reference Name: Address: Phone Number:
Reference Name: Address: Phone Number:
Reference Name: Address: Phone Number:

Employment Experience (Must cover last 3 years - CDL Drivers must cover last 10 years)

Employer: Dates Employed

From: To:

Work Performed:
Address: Hourly Rate/Salary

Starting: Final:
Supervisor: Telephone:
Job Title: Reason for Leaving:


Employer: Dates Employed

From: To:

Work Performed:
Address: Hourly Rate/Salary

Starting: Final:
Supervisor: Telephone:
Job Title: Reason for Leaving:


Employer: Dates Employed

From: To:

Work Performed:
Address: Hourly Rate/Salary

Starting: Final:
Supervisor: Telephone:
Job Title: Reason for Leaving:


Employer: Dates Employed

From: To:

Work Performed:
Address: Hourly Rate/Salary

Starting: Final:
Supervisor: Telephone:
Job Title: Reason for Leaving:

Employer: Dates Employed

From: To:

Work Performed:
Address: Hourly Rate/Salary

Starting: Final:
Supervisor: Telephone:
Job Title: Reason for Leaving:

Aevenia, Inc.
3030 24th Avenue South
Moorhead, MN 56560
218-284-9500 - FAX: 218-287-1963

The way energy moves.

Copyright 2009 Aevenia, Inc. All Rights Reserved

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