Heavy Equipment Dozer
Resume:
PAGE: * EMPLOYMENT APPLICATION MILLER PIPELINE CORP.
*/**/** *.*. BOX 34141
INDIANAPOLIS, IN 46234
APP# 76581 USER ID Walter3
General Information
SOCIAL SECURITY NUMBER ***-**-****
APPLICANT WALTER A LEE III
3482 SUPPLY ROAD
CARET, VA 22436
HOME PHONE 804-***-**** CELL PHONE 804-***-****
E-MAIL ADDRESS ***********@*****.***
LAST ADDRESS N/A
,
PREVIOUS ADDRESS N/A
,
ALLOW BACKGROUND/DRUG TST Yes
EMPLOYMENT STATUS Employed
HIGHEST GRADE COMPLETED Graduated High school
Have you ever been arrested for or
convicted of a crime that has not been
expunged by a court?
No
Emergency Contact 1 Sharee Garnett Sister 804-***-**** Emergency Contact 2 Tammy Lee Sister 703-***-****
Position Information
POSITION OF INTEREST
Laborer
Operator
Foreman
MACHINE OPERATOR
PRIMARY AREA OF INTEREST Virginia
MINUMUM SALARY 25.00
WANT TO WORK Full-time
DATE COULD BEGIN 02/20/18
HOURS AVAILABLE 50
How did you hear about this position?
Employee Referral
If referred by employee or customer
please provide their name
Terry Ferguson
RELOCATE TO:
Virginia
Miller Pipeline Information
Have you worked at Miller previously?
No
Have you reviewed the job description on
our website or have the job requirements
been explained to you for the position
you are applying for?
Yes
Do you understand the requirements?
Yes
Can you perform the job requirements
with or without reasonable accomodations
Yes
PAGE: 2 EMPLOYMENT APPLICATION MILLER PIPELINE CORP. 2/13/18 P.O. BOX 34141
INDIANAPOLIS, IN 46234
APP# 76581 USER ID Walter3
Driving License and History
I certify I do not have more than one
motor vehicle license, the information
for which is listed below.
WAL
If you are applying for a field position
or any other involving driving a company
vehicle, please indicate if you hold a
current CDL license.
No
Class of CDL N/A
CDL Endorsements N/A
LICENSE STATE VA
LICENSE NUMBER T63401450
LICENSE TYPE Operators
LICENSE EXPIRES 01/21
If you do not have a CDL, are you
willing to obtain a CDL & DOT physical?
Yes
Have you ever been denied a license,
permit, or priviledge to operate a motor
vehicle?
No
Has any license, permit, or priviledge
ever been suspended or revoked?
Yes
Have you ever been convicted of DWI, DUI
or BAC?
No
Have you ever been convicted of reckless
driving?
No
License was suspended due to failure to pay a fine timely. It has been taken car e of and restored.
Date of Birth 01/03/71
Safety Information
Have you ever been nominated for a
safety award or formally recognized for
positive safety performance?
Yes
Was recognized for no incidents on the job while operating machinery. Have you ever participated in a safety
committee or other work-related
initiative?
Yes
Trained fellow employees on Flag Safety
Have you received formal disciplinary
action for a safety violation at any of
your previous employers in the past 5
years?
No
Employment record and Military service
Are you currently working for the
employer listed below?
PAGE: 3 EMPLOYMENT APPLICATION MILLER PIPELINE CORP. 2/13/18 P.O. BOX 34141
INDIANAPOLIS, IN 46234
APP# 76581 USER ID Walter3
Yes
May we contact this employer?
No
Were you discharged or asked to resign
from this company?
No
Did you operate a vehicle requiring a
CDL?
No
COMPANY NAME Henderson Construction
39 Powell Lane
Fredericksburg, VA 22406
EMPLOYED FROM 11/16 TO CURRENT
SALARY $18/Hour
SUPERVISOR Mark
JOB TITLE Foreman
PHONE 540-***-****
JOB DUTIES Operate all heavy equipment such as
Loader, Bull Dozer, Escavator
Reason for leaving or unemployment.
pay and hours
Were you subject to Federal Motor
Carrier Safety Regulations?
No
Was any job you held with this employer
designated as a safety sensitive func-
tion in any DOT regulated mode subject
to alcohol & controlled substances test?
No
Previous Employer 1
Were you discharged or asked to resign
from this company?
No
Did you operate a vehicle requiring a
CDL?
No
COMPANY NAME Northern Pipeline
10109 Residency Road
Manassas, VA 20110
EMPLOYED FROM 04/15 TO 11/16
SUPERVISOR Tahad Moore
JOB TITLE Foreman
PHONE 703-***-****
JOB DUTIES Operated heavy equipment such as
Loader, Bull Dozer, Escavator, Dump Truck
REASON LEAVING Job site in MD, Opportunity closer to home Were you subject to Federal Motor
Carrier Safety Regulations?
No
Was any job you held with this employer
designated as a safety sensitive func-
tion in any DOT regulated mode subject
to alcohol & controlled substances test?
No
Previous Employer 2
Were you discharged or asked to resign
from this company?
No
PAGE: 4 EMPLOYMENT APPLICATION MILLER PIPELINE CORP. 2/13/18 P.O. BOX 34141
INDIANAPOLIS, IN 46234
APP# 76581 USER ID Walter3
Did you operate a vehicle requiring a
CDL?
No
COMPANY NAME SW Rodgers
5816 Wellington Road
Gainsville, VA 20155
EMPLOYED FROM 09/13 TO 03/15
SUPERVISOR Will Hemperly
JOB TITLE Foreman
PHONE 703-***-****
JOB DUTIES Operated heavy equipment such as
Dozer, Loader, Escavator, Dump truck
REASON LEAVING Better Pay, hours
Were you subject to Federal Motor
Carrier Safety Regulations?
No
Was any job you held with this employer
designated as a safety sensitive func-
tion in any DOT regulated mode subject
to alcohol & controlled substances test?
No
Questionnaire for Field Positions
Are you available to work overtime on a
regular basis if required?
YES
Are you available to work occasional
weekends, evenings, or holidays as the
work requires?
YES
Occasionally this job may require
"Emergency Call Out". Are you ableto be
called for "Emergency Call Out"?
YES
This job requires working outdoors daily
in various types of weather conditions
including rain, snow, cold, heat, and
humidity. Are you willing and able?
YES
This job requires working around moving
equipment and heavy equipment. Are you
willing and able to work in this type of
environment?
YES
This job requires wearing safety equip.
such as, but not limited to, ear plugs
safety helmets, goggles, safety vests, &
workboots/shoes. Are you willing?
YES
This job may require repeated bending,
reaching, and lifting up to 50 pounds on
a regular basis. Are you able to do
these functions with or without a ccom?
YES
Jobs in our industry require moving from
one job site to another. Please
indicate your ability to travel to job
sites by checking all that apply
Occasional out of state travel
Do you have Gas Pipeline construction
experience?
Northern Pipeline
PAGE: 5 EMPLOYMENT APPLICATION MILLER PIPELINE CORP. 2/13/18 P.O. BOX 34141
INDIANAPOLIS, IN 46234
APP# 76581 USER ID Walter3
Do you have experience operating heavy
equipment?
I have experience in all my jobs operati
ng all heavy equipment on site.
Do you have experience in other types of
construction?
Yes, I am able to operate all machinery
needed from ground breaking to finished
product. I am very experienced on work
site operations.
DOT Qualifications process
Have you ever held DOT Operator
Qualifications?
No
Do you have an OQ card and will you
present it to Miller Pipeline for
validation if hired?
No
Driving Experience - NONE
Accident History - NONE
Traffic Convictions and Forfeitures - NONE
Affirmative Action
SELF-IDENTIFY I do not
APPLICANT ELECTRONIC SIGNATURE: WALTER A LEE III DATE: 2/13/18 APPLICANT SIGNATURE: DATE:
Contact this candidate