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

Full Name *

Name of applicant

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date of birth *

Cell Phone *

Email *

A Valid Email address is required.

Emergency Contact *

First

Last

Name of an Emergency Contact

Emergency Contact Phone# *

Relationship of Emergency Contact *

Relationship of Emergency Contact

2nd Emergency Contact

First

Last

2nd Emergency Contact

2nd Emergency Contacts Phone#

Flagging Certification

Flagging certification. *

National ATSA Certification

Please check to confirm you are ATSA Certified.

Driving Experience

Please list in detail your experience driving a truck with trailers attached, driving TMA’s. You must be able to show a valid drivers license and social security # as a condition of employment. A CDL is not required as a condition of employment.

Please list all Driving experience that relates to your work qualifications. *

Required Equipment to Perform Job Safely

1. Stop and Slow 24″x24″ retro reflective paddle,
2. Class 3 retro reflective pants and vest,
3. Orange hard hat
4. Work boots,
5. Safety glasses
6. Contact radios
7. Cooler

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

Yes
No

What skills do you possess that will help you perform in this position *

Please list all equipment you have used in the past. (i.e. – Operate an Impact, use a Post Driver, Skill Saw and any driving/trailer hauling experience)

Please check off any of the following duties that you have performed

installed signs
build signs
mounted signs to post
participated in lane closures

Please check all that you have physically done on the job.

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

Yes
No

If you answered Yes to the question of resignation of dismissal by an employer please explain the circumstances of each Yes answer below: (copy)

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

Start date

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 of felony conviction, please explain the circumstances of each Yes answer below:

If hired, you will be required to show proof of your legal right to work in the U.S.? *

Yes
No

Traffic Control Experience – List the Name of the Company, 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

Special Skills *

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

Do you have your own reliable transportation? *

Yes
No

Getting a ride to work, taking the bus, getting picked up by a friend, etc. is not considered reliable transportation and is a condition of employment.

Is your transportation a Truck *

Yes
No

This is not a requirement, but it is a preference

Statement of certification *

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

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