Online Application Please fill out this application form for all open positions with TCCI or Chase Contractors. Position Applying For*LaborerOperatorForemanWelderTruck DriverOther If applying for a position not listed above please specify: Name* Phone Number* Email* Address* Street Address City State / Province / Region Postal / Zip Code Month & Day of Birth Are you over the age of 21?YesNo Do you have a Class A CDL?YesNo Do you currently have HAZMAT Endorsement?YesNo Do you currently have a DOT Medical Card?YesNo What experience/qualifications do you have for the position you are applying for? What is the highest level of education completed? (List degrees, certificates, etc.) Resumé Cover LetterEmployment History- Please list your last 3 employers starting with the most recent. Company Name (Employer 1) Address (Employer 1) Street Address City State / Province / Region Postal / Zip Code Phone Number (Employer 1) Job Title (Employer 1) Employment Start and End Date (Employer 1) Salary (Employer 1) Reason for Leaving (Employer 1)Employment History Continued - Employer 2 Company Name (Employer 2) Address (Employer 2) Street Address City State / Province / Region Postal / Zip Code Phone Number (Employer 2) Job Title (Employer 2) Salary (Employer 2) Employment Start and End Date (Employer 2) Reason for Leaving (Employer 2)Employment History Continued - Employer 3 Company Name (Employer 3) Address (Employer 3) Street Address City State / Province / Region Postal / Zip Code Phone Number (Employer 3) Job Title (Employer 3) Salary (Employer 3) Employment Start and End Date (Employer 3) Reason for Leaving (Employer 3)Driving History License # State Class Expiration Date Vehicles OperatedStraight TruckTractor & Semi-TrailerTractor - Two Trailersother List any accidents, traffic violations & forfeitures for the past 5 years. Have you ever been denied a license, permit, or privilege to operate a motor vehicle?YesNo Has any license, permit, or privilege ever been suspended or revoked?YesNo Have you ever been convicted of a felony?YesNoReference 1 Contact Name (Reference 1)*FirstLast Phone # (Reference 1) Company (Reference 1) How long have you known this person? (Reference 1) Relationship to you (Reference 1):Reference 2 Contact Name (Reference 2)*FirstLast Phone # (Reference 2) Company (Reference 2) How long have you known this person? (Reference 2) Relationship to you (Reference 2):Reference 3 Contact Name (Reference 3)*FirstLast Phone # (Reference 3) Company (Reference 3) How long have you known this person? (Reference 3) Relationship to you (Reference 3):Acknowledgement I 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 provided 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 have completed this application, and all information provided herein is true and complete to the best of my knowledge.*I agreeI do not agreeSubmitReset
