Fill out the application form below if you are a dependable, experienced, quality oriented individual looking
for a bright future in the pavement marking industry.

Road Markings, Inc. offers a competitive salary and excellent benefits, including a 401K plan, medical/dental insurance,
vacation, a per diem while traveling, and life insurance.

Road Markings, Inc. is a drug-free workplace.

Employment Application

Personal Information

Name (Last, First):

Email Address:  Phone Number:

Home Address:
Street:  City:

State:  Zip:  

Social Security Number:

Driver's License Number   State:  Type:

Position:  Starting Date:

Desired Pay Rate: $ /hour

Are you currently employed?  No         Yes

If so, may we contact your employer?   No          Yes

Ever applied to Road Markings, Inc. before?  No         Yes

Referred by:

Education

Education Name/Location Years Degree Major
High School:
College:
Trade School:
Other:

Military Service

Branch:   Served from  to 

Honorably discharged?   Yes         No

If no, what type of discharge:

Employment History

Provide minimum 3 years history.

Employer Date
Name: From: To:
Address: Position:
City:  State:  Zip: Salary/Wage:
Contact:  Phone: Reason:
Employer Date
Name: From: To:
Address: Position:
City:  State:  Zip: Salary/Wage:
Contact:  Phone: Reason:
Employer Date
Name: From: To:
Address: Position:
City:  State:  Zip: Salary/Wage:
Contact:  Phone: Reason:

Commercial Drivers License

Fill this section out only if you hold a CDL.

Applicants are required to list additional addresses they have resided at
in the past three years.

Street: City: State: Zip:
Street: City: State: Zip:
Street: City: State: Zip:

Date of birth:

Accident Record for the Past Three Years

Indicate any accidents on your record for the past three years.

Date Nature of Accident Fatalities Injuries

Traffic Convictions/Forfeitures for the Past Five Years

Location Date Charge Penalty

Experience and Qualifications

List each license or permit currently held.

State License No. Type/Class Expires

Driving Experience

Please include anything that applies.

Class of Equipment Type of Equipment (van, tank, etc.) From To
Straight Truck
Tractor and Semi
Trailer
Tractor - Two Trailers
Other

List states where you have operated for the past five years:

Special courses/training that will help you as a driver: