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APEIRON UTILITY CONSTRUCTION, LLC

TRAFFIC CONTROL SPECIALISTS LLC

526 Perkins Court

Grand Junction, CO 81504

(970) 257-7400

(970) 985-4577 FAX

APPLICATION FOR EMPLOYMENT

We consider applicants for all positions without regard to race, religion, creed, color, gender, national origin, citizenship status, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

Starting with your present or most recent employer, list all employment for at least the last 3 years. The Department of Transportation requires commercial driver applicants to list all employers for an additional 7 year period where the applicant operated a commercial motor vehicle including the dates of employment and the reasons for leaving such employer.

Employer #1

Dates of Employment
Hourly or Salary Wage

Employer #2

Dates of Employment
Hourly or Salary Wage

Employer #3

Dates of Employment
Hourly or Salary Wage

Employer #4

Dates of Employment

ACCIDENT RECORD FOR PAST 3 YEARS (start with most recent)

COMMERCIAL DRIVER APPLICANTS ONLY COMPLETE THIS SECTION

Driver Qualifications

Driver Licenses & Permits

Driver Experience

Class Of Equipment

TYPE OF EQUIPMENT (VAN, TANK, FLAT, ETC.)

Date From:

Date To:

PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING

I authorize the investigation of any or all statements contained in this application and also authorize any person, educational institutions, law enforcement agencies, city, state, county and federal courts, military service, current employer, past employers, credit agencies, and organizations named in this application to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT, NOR GUARANTEE EMPLOYMENT FOR ANY DEFINATE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT MY EMPLOYMENT WITH APEIRON UTILITY CONSTRUCTION AND/OR TRAFFIC CONTROL SPECIALISTS IS AT WILL AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE, ALSO, THAT I MAY VOLUNTARILY TERMINATE MY EMPLOYMENT WITH APEIRON UTILITY CONSTRUCTION OR TRAFFIC CONTROL SPECIALISTS AT ANY TIME, WITH OR WITHOUT CAUSE. Apeiron Utility Construction/Traffic Control Specialists management reserves the right to require overtime and travel to other locations as normal conditions of employment. Apeiron Utility Construction and Traffic Control Specialists do drug and alcohol testing. All applicants for employment holding a commercial drivers’ license will be tested before they begin employment with Apeiron Utility Construction/Traffic Control Specialists. We do not intend to hire applicants who cannot successfully pass our initial substance abuse testing. I, THE UNDERSIGNED APPLICANT/EMPLOYEE of Apeiron Utility Construction and/or Traffic Control Specialists hereby consent to allow Apeiron Utility Construction/Traffic Control Specialists or company authorized facility to collect blood, urine, saliva or otherwise, specimens from me for post employment offer testing for the presence of alcohol, illegal drugs or controlled substances conducted pursuant to the Apeiron Utility Construction or Traffic Control Specialists Drug/Alcohol Workplace policy. Further, I give my consent for the release of the test results to the appropriate members of company management. I have read, understand and by my signature, consent to these statements. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I understand, also, that I am required to abide by all safety rules and regulations and employment guidelines of Apeiron Utility Construction and/or Traffic Control Specialists. I certify that this employment application was completed by me and that all entries on it and all information provided in this application and in the interview(s) are true and complete to the best of my knowledge.

INVITATION TO SELF-IDENTITY

This employer is a Government contractor subject to Executive Order 11246, as amended. In accordance wit the Executive Order, we will not discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. This order also requires Government contractors to take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, or national origin. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. Information you submit will be kept confidential, except that Government officials engaged in enforcing laws administered by the OFCCP may be informed. The information provided will be used only in ways that are not inconsistent with Executive Order 11246, as amended.

I Identify Myself As:

A Person Who:

RACE/ETHNICITY: