Name*
First Last
Email*
Phone*
Address*
Street Address Address Line 2 City State
Were You Referred by Anybody?
- Yes
- No
Referred By*

Employment Desired
Position Desired*
Date You Can Start*
MM slash DD slash YYYY
Salary Desired*
Are You Currently Employed*
- Yes
- No
Are You Legally Authorized to Work in the U.S.A.?*
- Yes
- No
Have You Ever Applied to Work At Keystone Trucking?*
- Yes
- No
When?*

Education
High School*
Years Attended*
Did You Graduate?*
- Yes
- No
GED or High School Equivalency Test (HiSET)?*
- Yes
- No
College or Trade School
Area(s) of Study
Years Attended
Did you Graduate?
- Yes
- No

Work History
Most Recent Employer*
Position*
Date Previous Job Started*
MM slash DD slash YYYY
Date Previous Job Ended*
MM slash DD slash YYYY

If still employed, use today's date
Salary
Reason for Leaving*

References
Name 1*
Business 1*
Phone 1*
Years Known 1*
Name 2*
Business 2*
Phone 2*
Years Known*
Name 3*
Business 3*
Phone 3*
Years Known*

Authorization
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

By submitting this application form, I accept to the terms above."
Consent*
I Agree to The Authorization Above

Disclosure
In connection with your application for employment and/or for evaluating you for continued employment, Jordison Construction, Inc. d/b/a Keystone Trucking ("Keystone Trucking"), its employees, and its agents will procure consumer reports on you which may contain personal and public record information such as your motor vehicle driving record (MVR) as part of the process of considering your candidacy as an employee and/or in your continued employment with our organization. In the event that information from any such consumer report (e.g. MVR report) is utilized in whole or in part in making an adverse decision, we will provide you with a copy of the consumer report and a description in writing of your rights under the federal Fair Credit Reporting Act.

The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. You will be given a summary of these rights together with this document.
Authorization
By my name below, I, the undersigned applicant, hereby authorize Keystone Trucking, its employees, insurers, and its agents to obtain and review one or more consumer reports about me, including MVRs, in order to be considered for employment with this company. If hired, this authorization will remain on file and shall serve as an ongoing authorization for Keystone, its employees (including human resources and management), its insurers, and its agents to procure consumer reports about me at any time during my employment. I release Keystone, its employees, insurers, and agents from liability for damages that may arise from the release of the information authorized by this Authorization.
Consent*
I agree to the Disclosure and Authorization Above.
Today's Date*
MM slash DD slash YYYY
Name*
First Last
Driver's License Number*

Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse
By entering my name below, I hereby provide consent to Jordison Construction, Inc., d/b/a Keystone Trucking ("Keystone") to conduct one or more limited queries of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. This consent shall remain in force for the duration of my employment with Keystone.

I understand that on an annual basis Keystone will conduct a limited query of my Clearinghouse information. I further understand that if a limited query conducted by Keystone indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Keystone without first obtaining additional specific electronic consent from me. If this occurs, I will need to be registered in the Clearinghouse as a driver and will need to login to the Clearinghouse website to provide the electronic consent for a "Full Query".

I further understand that if I refuse to provide consent for Keystone to conduct a limited or full query of the Clearinghouse, I will be prohibited from performing safety-sensitive functions for Keystone, including driving a commercial motor vehicle, as required by FMCSA's drug and alcohol program regulations.
Name*
First Last
Today's Date*
MM slash DD slash YYYY
Consent*
I agree to the Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse

EMPLOYMENT OPPORTUNITES

Belly Dump Truck Driver – Des Moines, IA

Keystone Trucking

To apply, please fill out the form below.

Step 1 of 8

Employment Desired

Education

Work History

References

Authorization

Disclosure

Authorization

Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse