Careers | Power Patch Infrared Specialists

"*" indicates required fields

Step 1 of 6

16%

PERSONAL INFORMATION

NAME*

First Middle Last Suffix

ADDRESS*

Street Address Address Line 2 City State ZIP / Postal Code

PHONE*

EMAIL*

DID YOU HEAR ABOUT US BY REFERRAL*

YES

If so, who?

EMPLOYMENT DESIRED

POSITION

DATE YOU CAN START*

MM slash DD slash YYYY

SALARY DESIRED*

Please answer all questions as completely as possible. If you are not sure how to answer a question write N/A. This questionnaire will help us learn what job may be the best fit for you as a new employee with our company. Share with us what skills and qualities you will bring to the team. We will train you the Power Patch quality standards and work required before starting on new projects.

ARE YOU CURRENTLY EMPLOYED*

YES

Who is your current employer?*

How long have you worked there?*

Are you currently laid off?

YES

May we contact your current employer?*

Yes

EDUCATION HISTORY

NAME & LOCATION OF YOUR HIGH SCHOOL

YEARS ATTENDED

Did you Graduate?*

Yes

SUBJECTS STUDIED

NAME & LOCATION OF YOUR COLLEGE

Did you Graduate?

Yes

SUBJECTS STUDIED

TRADE OR VOCATIONAL SCHOOL

YEARS ATTENDED

DID YOU GRADUATE

SUBJECTS STUDIED

SUBJECTS OF SPECIAL STUDY/WORK OR SPECIAL TRADE SKILLS

U.S. MILITARY SERVICE

RANK

FORMER EMPLOYERS

NAME & ADDRESS OF EMPLOYER

POSITION

START DATE

MM slash DD slash YYYY

END DATE

MM slash DD slash YYYY

SALARY

REASON FOR LEAVING

NAME & ADDRESS OF EMPLOYER

POSITION

START DATE

MM slash DD slash YYYY

END DATE

MM slash DD slash YYYY

SALARY

REASON FOR LEAVING

NAME & ADDRESS OF EMPLOYER

POSITION

START DATE

MM slash DD slash YYYY

END DATE

MM slash DD slash YYYY

SALARY

REASON FOR LEAVING

NAME & ADDRESS OF EMPLOYER

POSITION

START DATE

MM slash DD slash YYYY

END DATE

MM slash DD slash YYYY

SALARY

REASON FOR LEAVING

REFERENCES

NAME

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

BUSINESS

YEARS KNOWN

NAME

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

BUSINESS

YEARS KNOWN

NAME

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

BUSINESS

YEARS KNOWN

NAME

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

BUSINESS

YEARS KNOWN

EMPLOYMENT QUESTIONNAIRE FOR POWER PATCH INFRARED SPECIALISTS

DO YOU HAVE A VALID DRIVERS LICESNSE

YES

Do you have any points?*

Yes

If yes how Many?

Have CDL A?

YES

Have CDL B?

Yes

Tanker Endorsement?

Yes

Hazmat Endorsement?

Yes

CLASS

ENDORSEMENTS

DO YOU HAVE VALID MEDICAL CARD

YES

DO YOU HAVE A CURRENT DRIVERS ABSTRACT

YES

DRIVING EXPERIENCE

LOWBOY

TANDEM

ASPHALT EXPERIENCE

SHOVELING

PLATE COMPACTING

RAKING

TAMPING

List 3 Strengths

List 3 Weaknesses

What 3 skills and/or leadership qualities will you bring to Power Patch?

Do you consider yourself a team player?

Yes

Do you consider yourself to be organized?

Yes

Can you be ON TIME EVERY DAY?

Yes

Normal Start Time: 7:00 AM – Sometimes start time is 6:00 AM if working far IF start time is 7:00 AM, you are required in 15 minutes prior at 6:45 AM.

Do you have any experience with Infrared Equipment?

Yes

If YES what type of machine?

A. Truck Mounted Infrared Unit

B. Trailer Mounted Infrared Unit

C. Push Unit Small Infrared

How many years experience?

What was your position:

Crew Leader

Laborer

Roller Operator

Truck Driver

What Type of Infrared Unit Did you use?

KASI Infrared

RAY TECH Infrared

Keiser Morris Infrared

Other

Have you ever lead a crew:

Yes

Do you have computer experience?

IPAD

SURFACE PRO

MICROSOFT

APPLE

Do you have any experience with survey equipment?*

Laser lever

6’ level

Smart level

Transit

All of the above

Do you have ADA experience? What percentage of not less than ________% is required to be compliant?

For The Two Lists Below Rate Your Experience From 1-10 In Each Area 1 for No Experience At All. 10 For Expert Level Experienced.

INFRARED PATCHING EXPERIENCE: RATING

1. DRIVER OF TRUCK: Rating

2. ABLE TO LOAD AT PLANT: Rating

3. BACKING UP TO A PATCH: Rating

4. LAYOUT PATCH : Rating

5. RAKING ASPHALT: Rating

6. ROLLING WITH ASPHALT ROLLER: Rating

7. PLATE COMPACTOR: Rating

8. FILLING OUT PAPERWORK : Rating

9. TAKING BEFORE/ AFTER PHOTOS: Rating

TYPE OF WORK: RATING

1. POTHOLE PATCHING: Rating

2. DRAINAGE(PUDDLES): Rating

3. UTILITY PATCHES : Rating

4. LINESTRIPING: Rating

5. SPEED BUMP INSTALLATION: Rating

6. SPEED HUMP INSTALLATION: Rating

7. ADA RE- DESIGN: Rating

8. CONCRETE REPAIRS: Rating

9. SEALCOATING: Rating

10. CRACKFILLING: Rating

Type of Machinery Used:

1. POTHOLE PATCHING: Type of Machinery Used:

2. DRAINAGE(PUDDLES): Type of Machinery Used:

3. UTILITY PATCHES : Type of Machinery Used:

4. LINESTRIPING: Type of Machinery Used:

5. SPEED BUMP INSTALLATION: Type of Machinery Used:

6. SPEED HUMP INSTALLATION: Type of Machinery Used:

7. ADA RE- DESIGN: Type of Machinery Used:

8. CONCRETE REPAIRS: Type of Machinery Used:

9. SEALCOATING: Type of Machinery Used:

10. CRACKFILLING: Type of Machinery Used:

Comments

This field is for validation purposes and should be left unchanged.