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EMPLOYMENT APPLICATION

Position Desired*

    

Have you previously been employed by Summit Utilities, Inc. and it's subsidiaries.?

Yes

No

If yes, when?

Date available for Employment*

 Geographical Preference(s)*
Employment Interest*

Full Time

Flexible
Will you relocate?*

Yes

No
Do you have any relatives employed by Summit Utilities, Inc. and it's subsidiaries?*

Yes

No
If yes, state name and location:
How did you hear about this position?:*
PERSONAL
First Name* Middle Name* Last Name*
Address*    
City* State* Zip*
Telephone Number*    
   
Are you 18 years of age or older?*

Yes

No
Are you a U.S. Citizen or are you legally eligible for employment in the U.S.A.?*

Yes

No
EDUCATION
School Name and Location Dates Attended Major Subject Graduated Diploma/Degree or GED
High School

Yes

No
College

Yes

No
Graduate School

Yes

No
Other

Yes

No
REFERENCES
List three business references that we may contact who are qualified to evaluate your work abilities.
Name of Company Contact Position Held Telephone Number
SPECIAL TRAINING SKILLS
Software
Hardware & Other Office Equipment
Typing/WPM Shorthand/WPM Personal Computer Ten Key/Adding Machine

Yes

No

Yes

No
Summarize any other skills, training and/or qualifications:
 
EMPLOYMENT HISTORY - To be completed by all applicants
Attention: Applicants who will drive a commercial vehicle, even occasionally, in intrastate or interstate commerce must provide information on those employers for whom the applicant operated a employers for whom the applicant operated a commercial vehicle within the last 10 years. DOT regulations provide that Summit Utilities, Inc. and it's subsidiaries. may contact all previous employers of the past three years.

Name of Employer:

 Address of Employer:

Start Date:

Leave Date:

 Start Salary:

End Salary:

Job Title: Name/Title of Supervisor:
May we contact your Supervisor? Phone Number:
Description of work performed Reason for leaving

Name of Employer:

 Address of Employer:

Start Date:

Leave Date:

 Start Salary:

End Salary:

Job Title: Name/Title of Supervisor:
May we contact your Supervisor? Phone Number:
Description of work performed Reason for leaving

Name of Employer:

 Address of Employer:

Start Date:

Leave Date:

 Start Salary:

End Salary:

Job Title: Name/Title of Supervisor:
May we contact your Supervisor? Phone Number:
Description of work performed Reason for leaving

Name of Employer:

 Address of Employer:

Start Date:

Leave Date:

 Start Salary:

End Salary:

Job Title: Name/Title of Supervisor:
May we contact your Supervisor? Phone Number:
Description of work performed Reason for leaving
To be completed by applicants who will be in a D.O.T. qualified position.
Summit Utilities, Inc. and it's subsidiaries. is engaged in a business that is subject to the rules and regulations set forth by the Department of Transportation. The questions
listed on this page are required by the Federal Motor Carriers Safety Regulations of all applicants for driver positions, in addition to other information
requested on this form.

To All Summit Utilities, Inc. Applicants for Employment - Notice of Drug Screening/Bonding

Summit Utilities, Inc. and it's subsidiaries., Inc. appreciates your interest in our company as a place of employment. Your qualifications will be given careful consideration. It is our policy to make employment decisions without regard to an individual's race, religion, gender, national origin, age, marital status, veteran status or disability. Summit Utilities, Inc. and it's subsidiaries. complies with the Drug-Free Workplace Act of 1988 and has a smoke-free work environment. Summit Utilities, Inc. and it's subsidiaries. is concerned with the health and safety of its employees, as well as the safety and well being of its customers and the general public. Therefore, we require and are required under D.O.T. CFR Part 192, 49 CFR Parts 199 & 40, as one of the steps in the hiring process; that all otherwise qualified applicants for employment consent and submit to a drug screen. This drug screen will require the applicant to provide a urine sample, which will be tested for the presence of any nonprescribed or controlled substances. A confirmed positive test result, or the refusal to submit to this or any subsequent random screenings will disqualify applicant or employee from further consideration for employment or continued employment if hired. Additionally, all accounting personnel will be required to be bonded, including but not limited to a criminal background check.

Personal Information

List all addresses for the last 3 years

 Street City State Zip How Long
Full name as shown on Driver's License Driver's License Number Issuing State
Do you currently hold a valid commercial driver's license (CDL)?

Yes

No
If yes, check license class

Class "A"

Class "B"

Class "C"
Check CDL endorsements:

Double/Triple Trailers

Tank Vehicles

Hazardous Materials
Has your license or permit to drive ever been suspended, denied, or revoked?

Yes

No

Driving Record

Class of Equipment Type of Equipment
(Van, Tank, Flat, ect)

Dates

 Approximate Number of Miles Driven
From To
Straight Truck



Tractor and Semi-Trailer



Tractor - Two Trailers



Other



Accident Record

Employer Month & Year Type of Accident Type of Equipment Death or Injuries City or County Charged Y/N

Traffic Convictions and Forfeitures for Past 3 Years (other than parking violations)

Location Date Charge Penalty

 

EMPLOYMENT AGREEMENT
* Currently only electronic resumes that have been created with Microsoft Office products are accepted.Please fax your resume to 720-981-2129 if you cannot provide a resume in the requested format. You may also mail your resume to:
Summit Utilities, Inc.
PO Box 270868
Littleton, CO 80127
Attn: HR
Upload Resume
I agree and understand that the employer and/or its agents may investigate my driving record, background, and employment history to ascertain any and all information pertaining to my record, whether same is of record or not. I release employers and persons named herein from all liability for any and all damages resulting from the furnishing and release of such information. I understand and agree
that this application for employment does not obligate the employer to employ me, and that any interviews granted may be at my expense.

Once a contingent offer of employment has been made, I agree to furnish any additional information and/or submit to oral, written, or physical examinations, including testing for the presence of non-prescribed, controlled substances, bonding, and pre-employment processing as may be required to complete the employment file.

I understand that Summit Utilities, Inc. and its subsidiaries., Inc. requires drug testing as a part of its selection and hiring process. I also understand that such drug testing will consist of taking of urine to detect the presence of controlled substances in my body further understand that if a confirmed positive test result indicates the presence of controlled substances or non-prescribed drugs in my body, I will be disqualified from further hiring consideration. I hereby give my consent to Summit Utilities, Inc. and it's subsidiaries. to administer drug testing procedures to me and to use the results thereof in further determining my employability with the company.

In consideration of my employment, I agree to conform to the rules and regulations of Summit Utilities, Inc. and it's subsidiaries., including signing an Employment or Executive Agreement. I understand and agree that should I become employed by Summit Utilities, Inc. and it's subsidiaries., I will be an employee at will. My employment can be terminated, with or without notice, at any time, with or without cause, at the option of either the company or myself.

I understand that any misrepresentation, omission, or false statement by me in this application, in any supplement thereto, or in any other corporate records including those used in connection with Summit Utilities, Inc. and it's subsidiaries.' drug testing procedures, will be sufficient grounds for not employing me, and may result in dismissal without notice and any time during my employment. I authorize present and former employers, and individuals I have listed as personal references, to furnish information about my employment record, including a statement of the reason for the termination of my employment, work performance, abilities, and other qualities pertinent to my qualifications for employment, hereby releasing them from any and all liability for damages arising from furnishing the requested information.

My signature certifies that this application was completed by me, the undersigned, and that all entries and information submitted are true and correct to the best of my knowledge. I further acknowledge that I have read the foregoing and fully understand and agree to the same.

I acknowledge and agree that by using my Full Name to electronically sign a form, I am affirming the certifications requested on the electronic form I sign using the Full Name just as if I had signed the form using my handwritten signature.*

ONCE YOU HAVE SELECTED "SEND", YOU WILL GET A PAGE THAT SHOWS "FORM SUBMISSION". THIS MEANS YOUR SUBMISSION AND ATTACHMENTS HAVE BEEN SENT SUCCESSFULLY. DUE TO HIGH VOLUMES, PHONE CALLS REGARDING RESUMES WILL NOT BE ACCEPTED AND MESSAGES WILL NOT BE RETURNED. ONLY THOSE RESUMES DETERMINED TO MEET THE QUALIFICATIONS OF THE POSITION OFFERED WILL BE CONTACTED.