DRIVER EMPLOYMENT APPLICATION
Fill Out Completely And Accurately

"An Equal Opportunity Affirmative Action Employer"

 
     
  BSP Driver Employment Application Online Form  
  We appreciate your interest in our organization and we are sincerely interested in your qualifications. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify a representative of the organization. All employment offers are conditional pending results of a pre-employment drug screen and background check.  
 
   
PERSONAL INFORMATION Fields Marked With * Are Mandatory
 
APPLICATION DATE (D/M/Y) *  
FULL NAME *
EMAIL ADDRESS *
TELEPHONE NUMBER *
ADDRESS
Street *
City *
State *
Zip *
Position(s) you are applying for *
Age (If under 21) *
Have you previously applied or worked for Border States Paving?
If yes, provide dates
Have you ever served in the military? *
Branch of service
Rank at discharge
Length of service
If yes, describe in full
(Conviction of a felony does not automatically bar employment, circumstances will be considered)
If hired, can you provide proof that you can legally work in the United States? *
(Proof of eligibility will be required upon employment)
List any friends or relatives other than spouse, currently employed at Border States Paving *
EDUCATION
  Number of Years Completed * Degrees Earned or Expected * Major Course of Study *
HIGH SCHOOL *
TRADE OR BUSINESS
COLLEGE OR UNIVERSITY
OTHER
AVAILABILITY
How did you learn about our available position(s)? *
Any restrictions on days/hours/weekends? *
Are you willing to travel if required? *
Are there specific days/hours that you cannot work? *
JOB RELATED SKILLS
Truck Driver Experience *
Equipment Operator Experience *
Other Relevant Experience OR Special Training *
   
Name *
Telephone *

I authorize you to make such investigations and inquiries of 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 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 provide 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 I have the right to:

  • Review information provided by current/previous employers;
  • Have errors in the information corrected by previous employers and for those 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."
   
WAIVED SIGNATURE * DATE (D/M/Y) *
PAST THREE YEAR RESIDENCY
ADDRESS # 1
Street *
City *
State *
Zip *


Number of Years *
ADDRESS # 2
Street
City
State
Zip


Number of Years
ADDRESS # 3
Street
City
State
Zip


Number of Years
ADDITIONAL EMPLOYMENT HISTORY
Please list your employment history for a total of 10 years as required by FMCSR.
(If additional room is needed please send us a separate email to hr@borderstatespaving.com).
PREVIOUS EMPLOYER #1:
Name *
Phone Number *
Street Address *
City *
State *
Zip *
Position Held *
From (Month/Year) *
To (Month/Year) *
Supervisor's Name and Phone Number *
Reason for leaving *
Were you subject to FMCSRs** while employed? *
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? *
 
PREVIOUS EMPLOYER #2:
Name
Phone Number
Street Address
City
State
Zip
Position Held
From (Month/Year)
To (Month/Year)
Supervisor's Name and Phone Number
Reason for leaving
Were you subject to FMCSRs** while employed?
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?
* Account for period between jobs
(Include dates (month/year) and reason)
 
PREVIOUS EMPLOYER #3:
Name
Phone Number
Street Address
City
State
Zip
Position Held
From (Month/Year)
To (Month/Year)
Supervisor's Name and Phone Number
Reason for leaving
Were you subject to FMCSRs** while employed?
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?
* Account for period between jobs
(Include dates (month/year) and reason)
EXPERIENCE AND QUALIFICATIONS
DRIVING EXPERIENCE
Do you have driving experience within the last 3 years?
CLASS OF EQUIPMENT TYPE OF EQUIPMENT
Check all that apply
DATES
Straight Truck
Van
Tank
Flat
Box
Belly
From   To
 
Tractor & Semi-Trailer
Van
Tank
Flat
Box
Belly
From   To
 
Tractor & Two Trailers
Van
Tank
Flat
Box
Belly
From   To
 
Other
Van
Tank
Flat
Box
Belly
N/A
 
   
ACCIDENT HISTORY (3 YEARS)
Have you had accidents within the last 3 years?
Date
(month/year)
Nature of Accident
(head on, rear-end, upset, etc.)
Number
of Fatalities
Number
of Injuries
Hazardous
Materials Spill?
   
TRAFFIC CONVICTIONS AND FORFEITURES (3 YEARS)
Have you had traffic convictions and forfeitures within the last 3 years?
Date
(month/year)
Violation
(Other than parking violations)
State of Violation Penalty
(Points, loss of license, etc.)
LICENSE INFORMATION
Section 383.21 FMCSR states "No person who operates a commercial motor vehicle shall at any time have more that one driver's license." I certify that I do not have more than one motor vehicle license, the information for which is listed below:
State *
License *
Expiration Date *
A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle? *
If yes, give details
B. Has any license, permit, or privilege ever been suspended or revoked? *
If yes, give details
APPLICATION CERTIFICATION
This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.
WAIVED SIGNATURE CONFIRMATION * DATE (D/M/Y) *
   
49 CFR PART 40.25(J)
Release & Documentation of Pre-Employment Testing Information
by Driver/Applicant for Border States Paving, Inc.
Driver/Applicant Name *
 
During the past two (2) years, have you tested positive on a pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety sensitive transportation work covered by the Department of Transportation (DOT) drug and alcohol rules? *
 
During the past two (2) years, have you refused to test on a pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety sensitive transportation work covered by the Department of Transport (DOT) drug and alcohol testing rules? *
 
If you answered yes to either of the questions above, please provide documentation of your successful completion of return-to-duty process.
 
DRIVER/APPLICATION WAIVED SIGNATURE * DATE (D/M/Y) *
   
OPTIONAL AFFIRMATIVE ACTION DATA FORM

Border States Paving, Inc. is committed to employing the most qualified applicants for available positions, regardless of race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, marital status or veteran status. In conjunction with that commitment, we have an Affirmative Action plan which is intended to encourage qualified women, veterans, minorities, and individuals with disabilities to apply for open positions. While special effort is made to encourage these individuals to apply, all candidates are considered equally once they have applied.

To determine whether we have met our goals for encouraging women, minorities, veterans, and disabled individuals to apply, we need to gather related information from all our applicants. Please consider providing us with the information requested below. Your participation is optional and your decision to provide or not to provide the information will in no way impact your consideration for the position. Furthermore, the information you provide will not be seen by the individuals evaluating your qualifications and determining whether or not you will be offered a position.

First Name
Last Name
Date (D/M/Y)
What position are you applying for?
How did you hear about this position?
(Select the most appropriate option
and provide source name if requested)
Friend or Family  
Walk-in  
Career Fair
Newspaper/Publication
Website
Other
Gender
(Select the most appropriate box
to indicate your gender)
Race/Ethnicity
(Select the option that you
most closely identify with)
American Indian or Alaskan Native
Persons having origins in any of the original peoples of North, Central, or South America and who maintain tribal affiliation or community attachment.
Asian or Pacific Islander
Persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands.
Black/African-American (not of Hispanic origin)
Persons having origins in any of the Black racial groups of Africa.
Hispanic or Latino
Persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
Mixed Race
Persons having origins in multiple races.
White (not Hispanic origin)
Persons having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Disability
(Do you consider yourself
as in any way disabled?)
Veteran Status
(Select the most appropriate box
to indicate your status)
 
Voluntary Self-Identification of Disability Form CC-305
OMB Control Number 1250-0005
Expires 1/31/2017
 

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

 
• Blindness
• Deafness
• Cancer
• Diabetes
• Epilepsy
• Autism
  • Cerebral palsy
• HIV/AIDS
• Schizophrenia
• Muscular dystrophy
• Bipolar disorder
• Major depression
  • Multiple sclerosis (MS)
• Missing limbs or partially missing limbs
• Post-traumatic stress disorder (PTSD)
• Obsessive compulsive disorder
• Impairments requiring the use of a wheelchair
• Intellectual disability (previously called mental retardation)
 
Please check one of the options below:
 
YES, I HAVE A DISABILITY (or previously had a disability)
NO, I DON'T HAVE A DISABILITY
I DON'T WISH TO ANSWER
 
Your Name   Today's Date (D/M/Y)
 
 
   
 
 
 
     
 
Border States Paving, Inc.
Human Resources
hr@borderstatespaving.com
4101 32nd St. N. - P.O Box 2586
Fargo, ND 58108
Ph 701-237-4860
Fax 701-237-0233