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Please fill out the attached application. After that we need to make sure you have a clean driving record and that our insurance carrier will cover you. To do this we need a few items.

Items needed to get Insurance looked at:

Copy of Driver’s License
Social security number or a copy of social security card
Copy of MVR (Motor Vehicle Record) You can get this online here.

Once you are approved by our insurance carrier we will then need to do a pre-employment physical and drug screen. This will be at no cost to you and we will work with you to schedule it at a time that works for you.

Step 1 of 4

Applicant Information
Name*
First Last
Date*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Valid Driver's License?*
- Yes
- No
CDL Classes*
CDL Endorsements*
Date Available*
MM slash DD slash YYYY
Desired Hourly Pay*
Position Sought*
Are you currently employed?*
Education
Highschool
Location
Graduate?-Degree?
Major/Subjects of Study
_
College or University
Location
Graduate?-Degree?
Major/Subjects of Study
_
Specialized Training, Trade School, etc...
Location
Graduate?-Degree?
Major/Subjects of Study
_
Other Education
Location
Graduate?-Degree?
Major/Subjects of Study
Please list your areas of highest proficiency, special skills or other items that may contribute to your abilities in performing the above mentioned position:

Previous Employment
Current or Most Recent Employer
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor
First Last
Job Title
Starting Salary
Ending Salary
Responsibilities
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason for Leaving
May we contact your previous supervisor for reference?
_
Past Employer
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor
First Last
Job Title
Starting Salary
Ending Salary
Responsibilities
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason for Leaving
May we contact your previous supervisor for reference?
_
Past Employer
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor
First Last
Job Title
Starting Salary
Ending Salary
Responsibilities
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason for Leaving
May we contact your previous supervisor for reference?
References
First Reference
Name
First Last
Relationship
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
_
Second Reference
Name
First Last
Relationship
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
_
Third Reference
Name
First Last
Relationship
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Background Check Disclosure
Due to recent legislation and the nature of Huber Grading and Land Development, Inc.’s (the “Company”) work, the Company is required to conduct background checks and investigations on all new and current employees. As part of the background check and investigation process, the Company utilizes an outside organization, First Advantage Background Services, Corp. (“First Advantage”), P.O. Box 105292, Atlanta, GA 30348, 1-800-845-6004, to conduct background investigations. As part of the background check and investigation process, First Advantage, another outside organization, or the Company itself, may investigate whether you have ever been placed on a Sexual Offender Registry (“SOR”) or required to register and report for regarding your SOR for any reason and at any time. If you have been placed on a SOR, the Company will continue to employ you if employment has been, or is, offered. However, as an employee, it is your affirmative duty to comply with all State and Federal SOR registration and reporting requirements. Failure to comply with any registration or reporting requirements is immediate grounds for termination. The Company assumes no responsibility for your failure to comply with SOR registration and reporting requirements. As a result, you should carefully police yourself, if you are required to report or register with a SOR, to make sure you have completely complied with all SOR registration and reporting requirements. In addition, if you are subject to an SOR’s registration and reporting requirements you are prohibited by Iowa law, Iowa Code § 692A.113, from working on any project sites in which the Company is engaged with a school or school district, whether public or private. Although following completion of the background check and investigation process the Company may be aware of your SOR status, it is your affirmative duty to inform your immediate supervisor if you are unable to work on a particular job site. You, as the employee, must exercise this duty with extreme caution. The failure to comply with this duty is grounds for immediate termination. No punitive or disciplinary action will be taken by the Company against you for properly complying with your duty not to work on a job site pursuant to your duty as a person subject to SOR registration and reporting. If you have any questions regarding this policy you should speak with your supervisor.
Acknowledgement
I, the undersigned, hereby acknowledge that as an employee, or prospective employee, of Huber Grading and Land Development, Inc., that I have read and understand the foregoing Background Check Disclosure. I further affirm that I have read and understand my duties as an employee if I happen to be subject to SOR registration and reporting, and that if I fail to comply with my requirements as a person subject to SOR registration and reporting, or fail to comply with my duty as an employee that any such failures are grounds for termination.
Signature*
By submitting my name, I understand that I am signing this Acknowledgment/Disclosure electronically. I agree that my electronic signature is the legal equivalent of my manual signature on this Acknowledgment/Disclosure
Date*
MM slash DD slash YYYY

Disclosure Regarding Background Information
Huber Grading and Land Development, Inc. (the “Company”) may obtain information about you for employment purposes from a third party consumer reporting agency. Thus, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records (“driving records”), verification of your education or employment history, or other background checks. Credit history will only be requested where such information is related to the duties and responsibilities of the position for which you are applying. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report and a copy of any report about you. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your education and/or employment history conducted by First Advantage Background Services, Corp. (“First Advantage”), P.O. Box 105292, Atlanta, GA 30348, 1-800-845-6004. The scope of this notice and authorization is all encompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and throughout the course of your employment to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.
Acknowledgement and Authorization
I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORT ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by the Company at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by First Advantage, P.O. Box 105292, Atlanta, GA 30348, 1-800-845-6004, another outside organization acting on behalf of the Company, and/or the Company itself. Their Privacy Policy can be reviewed at http://www.fadv.com/pirvacy-policy/. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.
Name*
First Middle Last
Signature*
By submitting my name, I understand that I am signing this Acknowledgment/Disclosure electronically. I agree that my electronic signature is the legal equivalent of my manual signature on this Acknowledgment/Disclosure
Date*
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

Step 1 of 4

Applicant Information

Education

Previous Employment

Current or Most Recent Employer

Past Employer

Past Employer

References

First Reference

Second Reference

Third Reference

Background Check Disclosure

Acknowledgement

Disclosure Regarding Background Information

Acknowledgement and Authorization