Application for Employment
CCI provides equal opportunity for all qualified applicants and employees without regard to race, color, gender, national origin,
religion, age, sexual orientation, gender identity, genetic information, physical or mental disability, pregnancy, marital status,
status as a protected veteran, or any other status protected by federal, state, or local law. CCI also provides reasonable
accommodations to qualified individuals with disabilities, in accordance with the Americans with Disabilities Act and
applicable state and local laws. A copy of CCI's Affirmative Action Program (AAP) is available for review upon request.
APPLICANT: READ AND ENTER YOUR INITIALS BEFORE SUBMITTING THIS APPLICATION.
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I understand that the information will be used and that prior employers will be contacted for purposes
of investigation as required by 301.23, of the Federal Motor Carrier Safety Regulations.
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Furthermore, in making this application for employment, I understand that an investigation may be
made whereby information is obtained through personal interviews with third parities such as family
members, business associates, financial sources, friends, neighbors, or others whom I am acquainted.
This inquiry includes information as to my character, general reputation, personal characteristics, mode
of living, or whichever may be applicable. I have the right to make a written request within a reasonable
period of time for a complete and accurate disclosure of additional information concerning the nature
and scope of the investigation in compliance with Section 606-(A) (1) of the Fair Credit Reporting Act.
(by entering your initials, you signify your agreement with the above statements)
Special Skills and Qualifications
(Indicate number of years experience n the box next to each skill.)
Other Skills
Certification, Authorization and Agreement
By submitting this application, I herby certify that all statements made are complete and true, to the best of my
knowledge. I understand and agree that any false or misleading statements shall be considered sufficient
cause for employment disqualification or discharge from employment. I authorize my current and former
employers to provide Carstensen Contracting all available information regarding employment. I authorize all
schools, colleges and universities that I have attended to provide Carstensen Contracting all available
information regarding my education. I understand that, as a condition of employment, I must provide
documentation to Carstensen Contracting within three (3) days after my employment to prove United States
citizenship or the right to work in the United States. I authorize Carstensen Contracting to review all driving
record information available.
Today's Date: 12-07-2022
