Apply Position Applying For:*SelectLaborerOperatorSupertindentManagerOfficeLocation Applying For:*SelectByron, GaCartersville, GaColumbus, GaLocust Grove, GaRichmond Hill, GaValdosta, GaColumbia. SCSpartanburg, SCSummerville, SCCleveland, GAAPPLICANTS MUST READ AND SIGN BELOW I hereby authorize Fortson-Peek Company, Inc. and Peek Pavement Marking, LLC -- hereafter referred to as "Peek" -- to investigate my past employment, education, criminal background history, credit history, driving record, medical history, worker's compensation history, military service, and other matters as may be necessary in arriving at decision relating to my employment. Further, I release my previous employers, personal referees and all other responders to Peek inquiries from liabilities of damages on account having furnished information about me in good faith and in accordance with applicable laws. I understand that current and/or previous employers will be contacted for the purpose of investigating my records. In particular, I authorize Peek to seek information concerning my criminal background history, my driving history, my safety performance history, and my participation in -- and results of -- employer drug and alcohol testing (including refusals) in accordance with Federal Motor Carrier Safety Regulations (FMCSR). Accordingly, I acknowledge my consent -- with special regard to governemnt law enforcement agencies, related third party report services, and other persons or organizations holding such information about me -- to share these records with Peek, releasing them from any liability for their contributions. I acknowledge my right: 1)to review information provided by previous employers; 2) to have errors int the information corrected by previous employers and for those previous employers to resend the corrected information to the prospective employer; and 3) to have a rebuttal statement attached to the alleged erroneous information if the previous employer(s) and I cannot agree on the accuracy of the information. Should I become a Peek employee, I acknowledge the requirement of periodic inquiries into my FMCSR -- related records during and after my period of employment. Accordingly, I extend my consent and release of liability for damages regarding persons or organizations involved in sharing my FMCSR records during and beyond my period of employment. A telephone facsimile (FAX) or a scanned or photographic copy of this authorization shall be as valid as the original. I acknowledge that Peek seeks to hire -- without discrimination -- only lawful workers. I hereby confirm my elegibility for legal employment within the U.S., and I understand that my identification and my elegibilty for legal employment within the U.S. will be verified by the U.S. Department of Homeland Security and the Social Security Administration. I understand that I am entitled to a statement of my rights under the Fair Credit Reporting Act. I understand that information regarding sex, race and date of birth is requested in compliance with federal and state laws and will not be used to discriminate against me. I certify the accuracy and completeness of all information I provide in this application and during my subsequent interview(s). I understand that providing false or misleading information may result in rejection of my application or a termination of my employment and associated benefits in the event that I am employed with Peek. Finally, I understand that I am required to abide by all of Peek's rules and regulations. Signature of applicant indication agreement to the above terms.*Date* Date Format: MM slash DD slash YYYY Name* First Last Current Address* Current Address Current Address Line 2 City of Residence AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State of Residence ZIP Code Do you have residents in other states?*YesNoPlease list any additional residents in other states* Alternate Phone*Email* Who Referred You?Are you at least 18 years old?*YesNoAre you eligible for employment in the United States?*YesNoDo you have any experience in the field of pavement marking or road construction?*YesNoAre you currently employed?*YesNoCurrent or Former Employer NameCurrent Employer PhoneCurrent Employer Address Employer Address Employer Address Line 2 Employer City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Employer State Employer ZIP Code Reason for leaving:*SelectCommuteScheduleManagementTerminateLaid-offOtherIf other, state reason:*Length of employment?Please list any additional employment over the last 3 years Have you ever been employed at this company before?*YesNoIf yes, any other names you are known by?*Have you worked for a DOT Regulated Company in the past three years?YesNoDo you have any felony convictions?YesNoDo you have a valid drivers’ license?*YesNoApplication for Motor Vehicle ReportDate* Date Format: MM slash DD slash YYYY Name as it appears on driver's license*Date of Birth as it appears on driver's license* Date Format: MM slash DD slash YYYY Driver's License State*SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDriver's License Number*Driver's License Expiration Date* Date Format: MM slash DD slash YYYY APPLICANT STATEMENT: My signature authorizes release of information about my driving record to Fortson-Peek Co., and its subsidiaries.Applicant Signature:*Date of this application* Date Format: MM slash DD slash YYYY Have you held a driver’s license in any state other than your current licensed state in the last three years?*YesNoIf so, provide which state and license number of other State Drivers’ License*SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingOther State Drivers’ License Number**Do you have a CDL license?*YesNoApplication for Background Investigation* I hereby authorize release of information about me to Fortson-Peek Co., and its subsidiary companies for the purpose of arriving at a decision relating to my employment. Agencies and services -- including but not limited to the following types of organizations -- are released from all liability for potential damages relating to provision of these records: government policing authorities; government regulatory/information services; private, third-party information reporting services. I understand that background investigation as it relates to my current application for employment is the sole purpose for these records.Full Legal Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Other names you are known by*SexMaleFemalePrefer Not to AnswerRace*Date of Birth* Date Format: MM slash DD slash YYYY SSN*Applicant's Signature*Date* Date Format: MM slash DD slash YYYY Resume Upload