Start Your Career at MK Excavation Please Fill Out This Application To Apply To MK Excavation Name* Phone*Email Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Previous Address Address #1* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and 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IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Previous Address Address #2* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Emergency Contact Info:Contact #1* Phone*Contact #2* Phone*Are you legally able to work within the United States?* Yes No Have you ever been denied a license, permit, or privilege to operate a motor vehicle?* Yes No If yes, please explain:Has a license, permit, or privilege to operate a motor vehicle even been suspended or revoked?* Yes No If yes, please explain:Have you ever been convicted of DUI?* Yes No If yes, please explain:Have you ever failed a drug/substance test?* Yes No If yes, please explain:Have you ever been convicted of a felony?* Yes No If yes, please explain:MOTOR VEHICLE DRIVERS CERTIFICATION OF VIOLATIONS Traffic Violations* I certify that the following is a true and complete list of traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past 12 months.Date of Conviction MM slash DD slash YYYY Offense Location Type of Motor Vehicle Operated Date of Conviction MM slash DD slash YYYY Offense Location Type of Motor Vehicle Operated Date of Conviction MM slash DD slash YYYY Offense Location Type of Motor Vehicle Operated If no violations are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violation required to be listed during the past 12 months. Date of certification: Driver’s Signature: EXPERIENCE AND QUALIFICATIIONS Driver License Information State:* NO:* Type:* Exp. Date:* Driving/Operating/Skills Experience PLEASE NOTE: The actual experience time may be different than the total amount of time spent in operation. EXAMPLE: Perhaps, as part of your job description, you operate a dozer during February 2005 – August 2008. However, you only operate a dozer approximately twice a week during this time, thus your actual experience time equals 1 year. List of Examples: Dump Truck, Tractor & Semi-Trailer (End Dump/Heavy Equipment Hauling), Dozer (SPECIFY SIZE), Motor Grader, Scraper, Backhoe, Trackhoe (SPECIFY SIZE), Roller, Off-road Truck, Welding, Mechanical Skills Driving/Operating/Skills Experience*Class of EquipmentStart DateEnd DateTotal Years, Months, etc. of Actual Experience ACCIDENT RECORD FOR THE PAST 3 YEARS OR MORE ( recent accident first )*DateStart DateNumber of FatalitiesNumber of Injuries TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS*LocationDateChargePenalty PREVIOUS EMPLOYMENT DOT requires that employment for at least the past 3 years and/or Commercial Driving Experience for the past 10 years be shown. Previous Employer:*Name:Contact:Address:Phone:Position:Start Date:End Date:Reason For Leaving: REFERENCES (NON-RELATED)*Name:Address:Phone: I swear that the information included in this application is true and accurate to the best of my knowledge. I understand that M.K. Excavation, LLC has the right to refuse to hire me or take disciplinary action up to and including discharge if it discovers that I have falsified any of the information in this application. I understand that I will be required to take a pre-employment drug test prior to employment and will be randomly drug tested while employed with M.K. Excavation, LLC. Name* First Middle Last Digital Signature* Date* MM slash DD slash YYYY MK Excavation, LLC P.O. Box 863 Stillwater, OK 74076 I HEREBY CERTIFY THAT THIS FORM WAS COMPLETED BY ME, AND THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AS OF THE DATE HEREOF. I HEREBY CERTIFY THAT THIS FORM WAS COMPLETED BY ME, AND THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AS OF THE DATE HEREOF.I, the undersigned, hereby consent, authorize and release M.K. Excavation, LLC., (herein after referred to as the “Company”) to procure consumer reports on me including, but not limited to information concerning my character and general reputation. These reports may be obtained through, but not limited to the following sources: motor vehicle reports, social security number verifications, present and former addresses, criminal and civil history/records, and any other public records. I hereby release any and all persons, business entities, third party agencies, and governmental agencies providing information, whether public or private, from any and all liability, claims and/or demands, by me, my heirs or others making such claim or demand on my behalf for providing consumer report(s) and/or investigative consumer report(s) authorized therein. Further, if I am selected as an employee for the Company, I understand and authorize that periodic investigations may be requested for the duration of my association with the Company. I understand that this release and authorization shall remain in effect for the duration of my association with the Company. Additionally, I hereby authorize the Company to investigate any incidents of workplace misconduct made against or involving me both during and after the term of my association with the Company. I understand and agree that any information provided by me that is found to be false, incomplete, or misrepresented in any respect in the Company’s sole judgement, will be cause to cancel further consideration of my application for employment whenever such discrepancies are discovered. Further, I understand that by requesting this information that no promise of employment is being made. I am willing that a photocopy of this authorization will be accepted with the same authority as the original. Digital Signature* Date* MM slash DD slash YYYY Date of Birth* Month Day Year Gender* Male Female Drivers License #* Issuing State|* Daytime Phone Number*Other Names Used ( alias, maided, nickname )* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Image of your Driver's License*Max. file size: 32 MB.
