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Please answer the following questions completely by checking YES or NO. If YES, please explain:

Have you ever filled out an application with Acadian Contractors, Inc. before?


Have you ever been employed with Acadian Contractors, Inc. before?


Are you currently employed?

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status? (Proof of citizenship or immigration will be required upon employment)

On which date would you be available for work?


Are you available to work: (Select One)

Are you currently on a "lay-off" status & subject to recall from another company?

Can you travel if your job requires it?

Will you work overtime if asked?

Have you ever been arrested, convicted and/or adjudicated of a crime? (Convictions do not necessarily disqualify an applicant from employment)

Additional Information

Sec. 40.25(j) As the employer, you must also ask the employee whether he or she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive work covered by DOT agency drug and alcohol testing rules during the past two years.  If the employee admits that he or she had a positive test or a refusal to test, you must not use the employee to perform safety-sensitive functions for you, until and unless the employee documents successful completion of the return-to-duty process (see section paragraphs (b) (5) and (e).
EXPERIENCE  Give a complete record of all employment, including military, and reasons for periods unemployed during past 10 years.  Start with most recent.  If you have served in the armed forces attach a copy of your DD214.  If you have been self-employed list up to five of your major clients.  No "see resume" responses will be accepted.

Employment History:

Responsibilities and Duties

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Responsibilities and Duties

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Voluntary Equal Opportunity Questionnaire

As an equal opportunity employer, we hire without consideration to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, veteran status or disability. We invite you to complete the optional self-identification fields below used for compliance with government regulations and record-keeping guidelines.

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