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American Materials Company
Application for Employment
6131 Oleander Dr, Wilmington, NC 28403
Phone: (910) 779-1411
Fax: (910) 799-5411
(Answer all questions. Please print)
Applicants for all positions are considered without regard to race, color, religion, creed, gender, national
origin, age, marital status, sexual orientation, or any other legally protected status.
Applications will be subject to consideration for a period of 60 days. If the position has not been filled
within 60 days, a new application will be required. Please answer all questions. Incomplete applications
may be deemed invalid and withdrawn from consideration.
Position Applied For:___________________________ Date:_____________________
Name:________________________________ SS#___________ -______ -__________
Address:________________________________________________________________
Street/PO Box
City
State
Zip Code
Phone # ________________________ Date of Birth ________________
(Driver Applicants Only)
Have you worked here before?___________ From:____________ To:_____________
Reason for leaving:_______________________________________________________
Are you currently employed?________ If unemployed, how long?__________________
If offered employment, when would you be available to work? ____________________
Who referred you?_____________________ Rate of pay expected:_________________
List name and phone number of person to contact in case of an emergency:
__________________________________
___________________________________
Have you ever been convicted of a crime other than a minor traffic violation? _________
If yes, explain ____________________________________________________________
(A “yes” answer does not necessarily preclude employment consideration)
Education
Highest level of Education (select one):
Some High School
High School Diploma
Associates Degree
Bachelors Degree
Last School attended: ______________________
Name
Some College
GED
Post Graduate
__________________________
City/State
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Employment History
All applicants are asked to provide a brief history of their recent employment record. Driver applicants to
drive commercial vehicles intrastate, must provide employment information on all previous employers
during the past 3 years. Driver applicants to drive interstate, must provide previous employers during
the past 7 years. Use additional paper if necessary.
Note: List employers starting with the most recent
Employer:_______________________________ From:___________To:___________
Address:_______________________________________________________________
Contact Person:__________________________ Ph. # __________________________
Position Held:____________________________Wage/Salary:____________________
Reason for leaving:_______________________________________________________
Employer:_______________________________ From:___________ To:__________
Address:_______________________________________________________________
Contact Person:__________________________ Ph. # _________________________
Position Held:____________________________ Wage/Salary:__________________
Reason for leaving:_______________________________________________________
Employer:_______________________________ From:___________ To:__________
Address:_______________________________________________________________
Contact Person:__________________________ Ph.# __________________________
Position Held:____________________________ Wage/Salary:___________________
Reason for leaving:_______________________________________________________
Employer:_______________________________ From:___________ To:__________
Address:_______________________________________________________________
Contact Person:__________________________ Ph.# __________________________
Position Held:____________________________ Wage/Salary:__________________
Reason for leaving:_______________________________________________________
Employer:_______________________________ From:___________ To:__________
Address:_______________________________________________________________
Contact Person:__________________________ Ph. # _________________________
Position Held:____________________________ Wage/Salary:___________________
Reason for leaving:_______________________________________________________
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Employment Requirements
1. If applying for a driving position; must have a valid drivers license with appropriate
endorsements (if applicable)
2. Drivers: Must be physically qualified to drive a motor vehicle in accordance with
Subpart E, Part 391, FMCSR
3. Drivers: Must perform thorough daily inspection of assigned truck (or equipment) CDL
drivers must complete and document Pre-Trip and Post-Trip inspection of assigned
vehicle.
4. Drivers/Operators: Must insure that assigned vehicle is properly serviced and maintained.
5. Must be able to sit or stand for extended periods of time.
6. Must be able to lift up to 94 pounds.
7. Must be able to climb up and down stairs, ladders, ramps, etc. (if necessary).
8. Must obtain, through on the job training, a knowledge of the assigned job function.
9. Must deal with customers, co-workers, and general public professionally and
respectfully.
10. Must comply with all State, Federal, and Local laws and regulations.
11. Must be willing to perform work outside primary job function when work in assigned
work area is unavailable.
12. Must be able to wear and use required Personal Protective Equipment (PPE).
13. Must perform assigned job function safely and in compliance with all applicable
OSHA, MSHA, FMCSR, and Company safety policies, practices, and procedures.
14. Must adhere to directives issued by authorized; Facility Manager, Dispatcher, Job
Forman, and/or Immediate Supervisor.
15. Must performed assigned job function honestly, efficiently, and professionally.
Notice
As part of the company’s policy, and in compliance with the spirit and intent of the
Americans with Disabilities Act (ADA), the individual(s) doing the hiring shall consider
what, if any, accommodations can be made to hire qualified applicants regardless of
disabilities.
Applicant Statement
I have read and understand the Employment Requirements. I affirm and attest that I meet
the requirements for the position for which I am applying. If I am offered (and accept)
employment, I will, as a condition of employment, abide by the policies, practices, and
procedures of the company.
______________________________________
Signature of Applicant
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_______________
Date
For use when applying for a Driving position with American Materials Company
Driving Record
This section shall be completed by all applicants who are applying for a driving position
and/or all applicants who are applying for positions that may involve driving
or operating motorized company equipment.
List all vehicular accidents, traffic convictions, and forfeitures for the past 3 years.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
License Information
State
______
License Number
____________________
Type
Exp. Date
_____
____________
Experience
List courses taken, training completed, prior experience not shown elsewhere in this application
that may help in your work for this company.
______________________________________________________________________________
______________________________________________________________________________
To be read and signed by applicant.
I certify that the answers given herein are true and complete to the best of my knowledge. In the
event of employment, I understand that false or misleading information given in my application
or interview(s) may result in discharge.
_____________________________________
Signature of Applicant
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_____________
Date
Federal Motor Carrier Safety Association
Pre-Employment Screening Program
In connection with your application for employment with American Materials Company (AMC),
its employees, agents or contractors may obtain one or more reports regarding your driving, and
safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA).
When the application for employment is submitted in person, if AMC uses any information it
obtains from FMCSA in a decision to not hire you or take any other adverse employment
decisions regarding you, AMC will provide you with a copy of the report upon which its decision
was based and a written summary of your rights under the Fair Credit Reporting Act before
taking any final adverse action. If any final adverse action is taken against you based upon your
driving history or safety report, AMC will notify you that the decision has been taken and that the
action was based in part or in whole in this report.
AMC cannot obtain background reports from FMCSA unless you consent in writing.
If you agree that AMC may obtain such background reports, please read the following and sign
below.
By signing this form you will be authorizing AMC to access the FMCSA Pre-Employment
Screening Program (PSP) system to seek information regarding your commercial driving safety
record and information regarding your safety inspection history. Understand that you are
consenting to the release of safety performance information including crash data from the
previous five (5) years and inspection history from the previous three (3) years. Please understand
and know that this release of information may assist AMC to make a determination regarding
your suitability as an employee.
Further understand that neither AMC nor the FMCSA contractor supplying the crash and safety
information has the capability to correct any safety data that appears to be incorrect. Understand
that you may challenge the accuracy of the data by submitting a request to
https://dataqs,fmcsa.dot.gov If you challenge the crash or inspection information reported by the
State, FMCSA cannot change or correct this data.
Please note: Any crash or inspection in which you were involved will display on your PSP report.
Since the PSP report does not report, or assign, or imply fault, it will include all Commercial
Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes
were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without
violations, appear on the PSP report. State citations associated with FMCSA violations that have
been adjudicated by a court of law will also appear, and remain, on a PSP report.
I have read the above notice and understand that if I sign this consent form, AMC may obtain a
report of my crash and inspection history. I hereby authorize AMC and its employees, authorized
agents, and/or affiliates to obtain the information authorized above.
______________________________________
Signature
__________________
Date
______________________________________
Name (Print Please)
5
Fair Credit Reporting Act Disclosure &
Authorization
DISCLOSURE
In considering you as an applicant for employment or as a current employee, we may
choose to secure and use information contained in either a consumer report or investigative
consumer report about you obtained from a consumer reporting agency when: (1)
considering your application for employment (2) making a decision whether to offer you
employment, (3) deciding whether to continue your employment or (4) making other
employment-related decisions directly affecting you.
For explanation purposes, a "consumer reporting agency" is a person or business that, on a
cooperative nonprofit basis, or for monetary fees or dues, regularly assembles or evaluates
consumer credit information or other information on consumers for a person who has a legitimate
business need for the information or intends to use the information for employment purposes.
A "consumer report" means any written, oral or other communication of any information by a
consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity,
character, general reputation, personal characteristics, or mode of living which is used or expected to
be used or collected in whole or in part for the purpose of serving as a factor in establishing your
eligibility for employment purposes.
An "investigative consumer report" means a consumer report or portion thereof in which information
on your character, general reputation, personal characteristics, or mode of living is obtained through
personal interviews with your neighbors, friends, or associates reported on or with others with whom
you are acquainted or who may have knowledge concerning any such items of information.
In the event an investigative consumer report is prepared, you may request additional disclosures
regarding the nature and scope of the investigation requested as well as a written summary of
your rights under the Fair Credit Reporting Act.
AUTHORIZATION
By your signature below, you hereby authorize us to obtain a consumer report and/or an
investigative report about you in order to consider you for employment. If hired, this
authorization shall remain on file and shall serve as an ongoing authorization for us to
procure consumer reports at any time during the employment period.
____________________________________
Signature
__________________
Date
____________________________________
Name (Print Please)
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