Driver’s Application

Your application for employment can be completed by filling out the online form below or by downloading the Application for Employment and printing it for completion by hand and faxing it to (785) 228-2927 or mailing it to:  Koss Construction Company, 5830 SW Drury Lane, Topeka, Kansas 66604.

Everything marked with an asterisk (*) is required before submission. 

Driver’s Application

    Position(s) Applied For*

    Date of Application*

    First Name, Middle Name*

    Last Name*

    Social Security Number*

    Email*

    Phone Number*

    CellHome

    If hired, can you provide proof of age?*
    YesNo

    Have you ever been employed at Koss Construction before?*
    YesNo

    If so,

    Date from:

    To:

    Position

    Rate of Pay

    Reason for leaving?

    Rate of pay expected?*

    Are you now employed?*
    YesNo

    If no, how long since your last employment?

    List your addresses of residency for the past 3 years.

    Current Address

    Street

    City, State, Zip Code

    How Long? (Month/Year to Month/Year)

    1.Previous Addresses

    Street

    City, State, Zip Code

    How Long? (Month/Year to Month/Year)

    2.Previous Addresses

    Street

    City, State, Zip Code

    How Long? (Month/Year to Month/Year)

    Are you eligible for employment in this country?*
    YesNo

    Date available for work?*

    Are you able to meet the attendance requirement of the position?*
    YesNo

    Name Friends or Relatives working at Koss Construction?*

    Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)?*
    YesNo

    If yes, please explain:

    II Employment History

    All applicants must provide the following information on all employers during the preceding 4 years. List complete mailing address, street number, city, state, zip code and reason for leaving.

    May we contact your former employers?*
    YesNo

    If not, which ones?

    Employer

    Name

    Address

    City, State, Zip Code

    Phone Number

    Contact Person

    Dates Employed
    From (Month/Year)

    To (Month/Year)

    Position Held

    Salary/Wage

    Reason for Leaving


    Employer

    Name

    Address

    City, State, Zip Code

    Phone Number

    Contact Person

    Dates Employed
    From (Month/Year)

    To (Month/Year)

    Position Held

    Salary/Wage

    Reason for Leaving


    Employer

    Name

    Address

    City, State, Zip Code

    Phone Number

    Contact Person

    Dates Employed
    From (Month/Year)

    To (Month/Year)

    Position Held

    Salary/Wage

    Reason for Leaving


    Employer

    Name

    Address

    City, State, Zip Code

    Phone Number

    Contact Person

    Dates Employed
    From (Month/Year)

    To (Month/Year)

    Position Held

    Salary/Wage

    Reason for Leaving


    Employer

    Name

    Address

    City, State, Zip Code

    Phone Number

    Contact Person

    Dates Employed
    From (Month/Year)

    To (Month/Year)

    Position Held

    Salary/Wage

    Reason for Leaving

    III Accident Record for Past 3 Years or More

    1. Date of Last Accident

    Nature of Accident (head-on, rear-end, upset, etc)

    Fatalities

    Injuries

    2. Date of Last Accident

    Nature of Accident (head-on, rear-end, upset, etc)

    Fatalities

    Injuries

    3. Date of Last Accident

    Nature of Accident (head-on, rear-end, upset, etc)

    Fatalities

    Injuries

    Traffic convictions and forfeitures for the past 3 years (other than parking violations). If none, write none.

    1. Location

    Date

    Charge

    Penalty

    2. Location

    Date

    Charge

    Penalty

    3. Location

    Date

    Charge

    Penalty

    IV Experience & Qualifications

    Driver's License

    State*

    License Number*

    Type*

    Expiration Date*

    A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?* YesNo

    B. Has any license, permit or privilege ever been suspended or revoked?* YesNo

    If yes, please explain:

    C. Have you operated a commercial motor vehicle in excess of one (1) year?* YesNo

    Driving ExperienceIf none, write none

    Straight Truck

    Type of Equipment (van, tank, flat, etc)

    Dates To:

    Dates From:

    Approx. Total Number of Miles

    Tractor & Semi-Trailor

    Type of Equipment (van, tank, flat, etc)

    Dates To:

    Dates From:

    Approx. Total Number of Miles

    Tractor-Two Trailers

    Type of Equipment (van, tank, flat, etc)

    Dates To:

    Dates From:

    Approx. Total Number of Miles

    Motorcoach-School Bus

    Type of Equipment (van, tank, flat, etc)

    Dates To:

    Dates From:

    Approx. Total Number of Miles

    Other

    Type of Equipment (van, tank, flat, etc)

    Dates To:

    Dates From:

    Approx. Total Number of Miles

    Summarize any training, licenses, and characteristics of yourself that may qualify you as being able to perform job-related functions for the position which you are applying.

    List safe driving awards you hold and from whom:

    VI Education

    Highschool*

    City, State*

    College

    City, State

    College

    City, State

    Other

    City, State

    V References

    1. Name*

    Address*

    City, State, Zip Code*

    Phone*

    2. Name*

    Address*

    City, State, Zip Code*

    Phone*

    TO BE READ AND SIGNED BY APPLICANT

    This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision.I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.I also understand that prior to being employed, I would be required to submit to a Drug Screen.

    Date*

    Name*

    Koss Construction Company participates in E-Verify to verify employee identity and work authorization.

    APPLICANT VOLUNTARY SELF-IDENTIFICATION FORM

    Applicants are considered for all positions without regard to race, color, sex, national origin, veteran status, or disability status.As an Affirmative Action/Equal Opportunity Employer, Koss Construction complies with government regulations and affirmative action responsibilities.

    Please complete the Applicant Voluntary Self-Identification Form to assist us with government record keeping, reporting, and other legal requirements.The data is for analysis and affirmative action purposes.Submission of information is voluntary and refusal to provide it will not subject you to any adverse treatment.The information will be kept confidential and will only be used in accordance with provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement.When reported, data will not identify any specific individual. Completion of information below is voluntary.Thank you for your cooperation.

    Referral Source – Please check one:

    Referred by Current EmployeeKoss Internet WebsiteWorkforce CenterNewspaper AdWalk-InJob FairSchoolOther (name of source)

    Applicant Affirmative Action Data – Please complete:

    Gender

    MaleFemale

    Race/Ethnicity

    Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.White (Not Hispanic or Latino) – CaucasianBlack or African American - A person having origins in any of the black racial groups of Africa.Native Hawaiian or Other Pacific Islander – A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.American Indian/Alaskan Native – A person having origins in any of the original peoples of North and South American (including Central America), and who maintains tribal affiliation or community attachment.Two or More Races – All persons who identify with more than one of the above five races.

    Veteran Status

    Please check all boxes below that apply. Identification of a veteran status is essential for effective affirmative action data collection and analysis. If you choose to identify your veteran status, the information you provide will be used for statistical purposes only and will not affect your employment in any way.

    Are you a veteran?

    YesNo

    If you are a Veteran, please select one or more of the categories below that apply to you:

    Vietnam Era Veteran: A veteran who: (1) Served on active duty in the U.S. military, ground, naval, or air service for a period o more than 180 days, and was discharged or released there from with other than a dishonorable discharge if any part of such active duty occurred: (a) in the Republic of Vietnam between February 28, 1961 and May 7, 1975; or (b) between August 5, 1964 and May 7, 1975 in all other cases; or (2) Was discharged or released from active duty for a service connected-disability if any part of such active duty was performed: (a) in the Republic of Vietnam between February 28, 1961 and May 7, 1975; or (b) between August 5, 1964 and May 7, 1975 in all other cases.Recently Separated Veteran: A veteran who was discharged or released from active duty in the U.S. Military within the last three (3) years.Special Disabled Veteran: A veteran of the U.S. military, ground, naval or aid service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans’ Affairs for disability – a) rated at 30% or more; b) rated at 10 or 20% in the case of a veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap; or c) a person who was discharged or released from active duty because of service connected disability.Other Protected Veteran: A veteran who served on active duty in the U.S. military ground, naval, or air service during was or in a campaign or expedition for which a campaign badge has been authorized under laws administered by the U.S. Department of Defense. The information required to make this determination is available at: http://www.opm.gov/veterans/html/vgmedal2.asp or by calling (310) 306-6752.

    Disability Status

    Please check the box below if applicable. Self-identification of disability status I essential for effective affirmative action data collection and analysis. If you choose to self-identify your disability status, the information you provide will be used for statistical purposes only and will not affect your employment in any way.

    Are you an individual with disabilities? (Definition of Disability: A person has a disability if he or she has a physical or mental impairment which substantially limits one or more major life activities; has a record of such impairment, or is regarded as having such impairment. A handicap is “substantially limiting” if it is likely to cause difficulty in securing, retaining or advancing in employment.)

    Yes, I am disabledNo, I am not disabled

    **Please submit form once. If it appears that the form didn't submit correctly, please go through your application and make sure that everything marked with an asterisk (*) is completed. Check your email inbox for verification that your application was submitted successfully.