traffic control services delaware and maryland, | Keeping Workers Safe On Our Highways

Full Name *

Name of applicant

Address 1 *

Address of Applicant

Address 2

Address of Applicant 2

City *

City

State *

State

Zip Code *

Zip Code

Home Phone#

Applicants Home Phone Number

Cell Phone# *

Applicants Cell Phone Number

Email *

A Valid Email address is required.

Which States are you currently certified in? *

National
Maryland

Please check all that apply.

Do you have all of your required equipment? Equipment listed below. *

Yes
No

Stop and Slow 24"x24" retro reflective paddle, Class 3 retro reflective pants and vest, orange hard hat, safety glasses, work boots, contact radios and a cooler.

Do you have experience driving big trucks? *

Yes
No

Big trucks such as Dump Trucks, TMA's, etc...

Do you have a valid CDL License? *

Yes
No

Do you have experience backing up a truck with a trailer attached? *

Yes
No

Do you own your own pickup truck? *

Yes
No

1. If offered a position, when can you report to work? *

Start date

2. If hired, can you show proof of your legal right to work in the U.S.? *

Yes
No

3. Have you ever been dismissed, or asked to resign, from any position? *

Yes
No

4. Have you ever been convicted of a felony, or a misdemeanor, which resulted in imprisonment? *

Yes
NO

A yes answer DOES NOT disqualify you for employment.

If you answered Yes to the questions 3 or 4, please explain the circumstances of each Yes answer below:

Emergency Contact *

First

Last

Name of an Emergency Contact

Emergency Contact Phone Number *

Emergency Contact Phone Number Format XXX-XXX-XXXX

Relationship of Emergency Contact *

Relationship of Emergency Contact

2nd Emergency Contact *

First

Last

2nd Emergency Contact

2nd Emergency Contact Phone #

2nd Emergency Contact Phone # Format XXX-XXX-XXXX

2nd - Relationship of Emergency Contact

2nd Relationship of Emergency Contact

Traffic Control Experience - List the Name of all of the Companies, Phone Number and Position Held *

Please list all contact information for the Traffic Control Company you worked for in the past. If NONE, Please type NONE in the field.

Do we have permission to Contact them

Yes
No

Do you have your own reliable transportation? *

Yes
No

Special Skills

Please list any special skills and the years of experience you have at each skill. (i.e. - carpentry, welding, electric, plumbing, etc...)

I certify that all of the statements made herein and on the enclosed resume are true and correct to the best of my knowledge. I authorize investigation of all statements herein recorded. I release from liability all persons and orginazations reporting information required by this application.

Type in your Full Name for Digital Signature *

First

Middle

Last

Typing in your name here will act as your digital signature for this employment application.

Checking this box will act as a digital signature *

Digital Signature Confirmation