Employment Application

DMJ Asphalt
An Equal Opportunity Employer

Name: ____________________________________________________________

Address: __________________________________________________________

City: _____________________________________________ Zip: ____________

Phone: ____________________________ Alt. Phone: ______________________

Social Security Number: __________________________________________

Drivers License Number: _______________________________ State: _____

License Class: A (  )  B (  )  C (  )  D (  )  (please check one)

Violations in past 5 years: Yes (  )  No (  )  (please check one)

If yes, please briefly explain: ___________________________________________

_________________________________________________________________

Employment History (List most recent first)

Dates of Employment
Company Name
& Phone Number
Position Held

From: __________

To: __________

   

From: __________

To: __________

   

Equipment Experience:

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

 

Any other comments you would like to add:

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Please complete and mail to:
DMJ Asphalt, Inc.
2392 Pioneer Trail
Medina, MN 55340
763-478-6878
E-mail: kari@dmjasphalt.com