Application

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Applications can be Mailed, E-mailed, or faxed to us at
811 Dearborn Ave Waterloo, Iowa 50704
PO Box 2592 Waterloo, Iowa 50704

                
                        
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Black Hawk Waste Disposal &
 Cedar Valley Recycling and Transfer

811 Dearborn Ave
Waterloo, IA 50703
(319)232-4150


Application
Please fill out completely for employment consideration



Which company are you applying for?*
			
					
					Black Hawk Waste Disposal
			
			
					
					Cedar Valley Recycling & Transfer
			
What position are you applying for?*
			
					
					Driver
			
			
					
					Office
			
			
					
					Shop
			
			
					
					Other

			
Name*
                            
                            
                                                    
                                                    First
                                                
                            
                                                    
                                                    Middle Initial
                                                
                            
                                                    
                                                    Last
                                                
                            
                        
Current Address* 
City* 
State* 
Zip* 
Previous Address 
(Last 3 years)
City 
State 
Zip 
Phone*
Email
                            
                        
Date of Birth* 
                    
                    
                          
                    
                
                
                    
                        Availability
			
					
					Part Time
			
			
					
					Full Time
			
How did you hear about this position?*
Are you currently employed
			
					
					Yes
			
			
					
					No
			
Date Available 
Wage Desired 
Have you worked for Black Hawk Waste/Cedar Valley Recycling before?
			
					
					Yes
			
			
					
					No
			
What year 
Are you at least 18 years of age?
			
					
					Yes
			
			
					
					No
			
Do you have reliable transportation to/from work.
			
					
					Yes
			
			
					
					No
			
Do you have a current and valid license to drive?
			
					
					Yes
			
			
					
					No
			
                    
                    
                          
                    
                
                
                    
                        Education
Last School Attended, please do not list CDL Education here.
School Name 
City 
State 
Major 
Diploma or Certificate 
Graduated
			
					
					Yes
			
			
					
					No
			
Year 
List any special training that will help you in this position 
Military Service
Branch of Service 
Service Start Date 
Discharge Date 
Status
			
					
					Honorable Discharge
			
			
					
					Dishonorable Discharge
			
                    
                    
                          
                    
                
                
                    
                        Work History
We are required by the department of transportation to send Safety Performance History Records Requests to all current and previous employers for commercial motor vehicle applicants.
Company Name* 
From Date 
To Date 
Address* 
City 
State 
Zip 
Your position 
Supervisor 
Phone*
Safety sensitive position (DOT)*
			
					
					Yes
			
			
					
					No
			
Description of duties 
Reason for leaving 
Company Name 
From Date 
To Date 
Address 
City 
State 
Zip 
Your position 
Supervisor 
Phone
Safety sensitive position (DOT)
			
					
					Yes
			
			
					
					No
			
Description of duties 
Reason for leaving 
Company Name 
From Date 
To Date 
Address 
City 
State 
Zip 
Your position 
Supervisor 
Phone
Safety sensitive position (DOT)
			
					
					Yes
			
			
					
					No
			
Description of duties 
Reason for leaving 
                    
                    
                          
                    
                
                
                    
                        References
Excluding friends and family
Name 
Phone
Relationship 
Name 
Phone
Relationship 
Name 
Phone
Relationship 
                    
                    
                          
                    
                
                
                    
                        License #* 
State* 
Expiration Date* 
Class*
			
					
					Class A
			
			
					
					Class B
			
			
					
					Class C
			
			
					
					Other
			
Do you have a valid medical card*
			
					
					Yes
			
			
					
					No
			
* You will be expected to provide proof upon being hired.
Expiration Date 
Driving School Name 
Graduate Year 
What CMV do you have experience drivingCheck all that apply

								
								Straight Truck
							

								
								Tractor and Trailer
							

								
								Tractor and Two-Trailer
							

								
								Other
							
Type of Equipment
								
								Van
							

								
								Tank
							

								
								Dump
							

								
								Flat
							
Describe {Other} 
How many years experience with this type of equipment 
Approximately how many total miles 
                    
                    
                          
                    
                
                
                    
                        Have you been involved in any accidents in the last three years, regardless of fault?
			
					
					Yes
			
			
					
					No
			
List any accidents you were involved in for the last three years, regardless of fault.
Date 
Type
			
					
					Head-on
			
			
					
					Rear-end
			
			
					
					Single Vehicle
			
			
					
					Intersection
			
			
					
					Other

			
Fatalities
			
					
					Yes
			
			
					
					No
			
Describe the accident 
Date 
Type
			
					
					Head-on
			
			
					
					Rear-end
			
			
					
					Single Vehicle
			
			
					
					Intersection
			
			
					
					Other

			
Fatalities
			
					
					Yes
			
			
					
					No
			
Describe the accident 
Do you have additional accidents to report?
			
					
					Yes
			
			
					
					No
			
Additional AccidentsPlease list all additional accidents, dates, type, fatalities, and explanations here. 

                    
                    
                          
                    
                
                
                    
                        Have you had any traffic violations in the past three (3) years, other than parking tickets?
			
					
					Yes
			
			
					
					No
			
List all traffic violations in the past three years, other than parking tickets.
Date 
Location 
Charge 
Disciplinary Action
Date 
Location 
Charge 
Disciplinary Action
Date 
Location 
Charge 
Disciplinary Action
Do you have additional traffic violations?
			
					
					Yes
			
			
					
					No
			
Additional Traffic Violations
Please list all additional traffic violations here.
Has your license, permit, or privilege to operate a vehicle ever been suspended, revoked or denied?
			
					
					Yes
			
			
					
					No
			
If yes, please explain 
                    
                    
                          
                    
                
                
                    
                        
  Driver Authorizations
Pre-Employment Drug Testing, Drug & Alcohol, Previous Employment, and Driving Record
General consent for limited queries of the FMCSA Drug & Alcohol Clearinghouse
Black Hawk Waste Disposal will hereafter be described as 'BHW'.
Drug & Alcohol Testing
  
    As a condition of qualification, a urine sample collection and controlled substance test is required. It is understood that a positive test for controlled substance based on the urinalysis test will medically disqualify an applicant from the operation of a commercial motor vehicle for Black Hawk Waste Disposal/Cedar Valley Recycling & Transfer.
   Black Hawk Waste Disposal/Cedar Valley Recycling & Transfer reserves the right to use an outside agency to maintain and conduct drug screening. This may include pre-employment, post-accident, random, or reasonable suspicion. Your written authorization will be required for the urinalysis test results to be given to any other parties.
  Part 40.25j requires Employers to ask Applicants whether he or she has tested positive or refused to test on any Pre-Employment alcohol or drug tests administered by an Employer to which the Applicant/Driver applied, but did not obtain safety sensitive transportation work covered by DOT agency alcohol and drug testing rules during the past two (2) years.
During the past two (2) years, have you tested positive on a Pre-Employment alcohol or drug test administered by an Employer in which you applied for, but did not obtain safety sensitive transportation work covered by Department of Transportation (DOT) drug and alcohol testing rules?*
			
					
					Yes
			
			
					
					No
			
During the past two (2) years, have you refused to test on a Pre-Employment alcohol or drug test administered by an Employer in which you applied for, but did not obtain safety sensitive transportation work covered by Department of Transportation (DOT) drug and alcohol testing rules?*
			
					
					Yes
			
			
					
					No
			
If you answered yes to either of the questions above, please explain below and provide documentation of your successful completion of the return-to-duty process required by part 40 subpart O.
                    
                    
                          
                    
                
                
                    
                        Safety Performance History Records Request & MVR 
  
    In accordance with the provisions of Section 604(b)(2)(a) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, subtitle D, Chapter I of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports are required by Sections 383, 413, and 391.23 of the Federal Motor Carrier Safety Regulations.
  
General consent for limited queries of the FMCSA Drug & Alcohol Clearinghouse (DACH Authorization)

I hereby provide consent to Black Hawk Waste Disposal to conduct a limited query of the FMCSA Commercial Driver’s License Drug & Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse.
I understand that if I refuse to provide consent for Black Hawk Waste Disposal to Conduct a limited query of the Clearinghouse, Black Hawk Waste Disposal will prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.
I further understand that this authorization will be used for a pre-employment query, and for annual queries.




Certification: I certify that I have read and understood the above requirements and how it affects my employment with Black Hawk Waste Disposal/Cedar Valley Recycling & Transfer and its subsidiaries and authorize Black Hawk Waste Disposal/Cedar Valley Recycling & Transfer to obtain the information authorized above.
Electronic Signatures. Each party agrees that this Agreement and any other documents to be delivered in connection herewith may be electronically signed, and that any electronic signatures appearing on this Agreement or such other documents are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility
Driver Applicant's Signature* 
Date* 
                    
                    
                          
                    
                
                
                    
                        Criminal Background Check & MVR Authorization
Black Hawk Waste Disposal / Cedar Valley Recycling and Transfer, hereafter described as 'BHW/CVR', desires to provide its staff and customers with a reasonably safe and secure environment and to provide reasonable protection for the financial and material assets of the company. It is appropriate in the employment process for the ability to screen persons for positions on the basis of specific criminal conviction records that raise a reasonable doubt as to an individual's fitness for a particular position.
This procedure is intended to insure the privacy of individuals while meeting the purposes of conviction record checks. This procedure will be followed when filling vacancies with new hires or internal transfers, in positions which are designated as sensitive. This procedure may also be followed in other situations where its use is reasonably deemed relevant to a specific employment decision.
When the use of criminal conviction or MVR records is appropriate, within the scope of the policy stated above, any such information must be reviewed by the General Manager as to its relevance to the specific employment decision to be made. This evaluation shall consider, but not be .limited to, the following factors: 
Falsification of application
Date of conviction
Subsequent employment records
Length of company service and work performance
Number and gravity of conviction(s) and the nature of the work to be performed
The potential opportunity through abuse of work related functions or situations, to cause loss or harm to the staff or to the financial or material property of BHW/CVR.

All employees are required to sign this release form allowing BHW/CVR to make a thorough criminal background check and gain access to their Motor Vehicle Report(MVR). Existence of a conviction record will not automatically disqualify the applicant/employee from employment. However, giving false information or omission of information may be grounds for denial of employment, discharge if hired, or termination of current employee.

Certification: I hereby affirm that I have supplied complete and correct information to all questions in this application and that I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand that falsification of information on this application could be cause for dismissal at any time after employment. I further authorize BHW/CVR to contact any company or persons mentioned in this application except those marked "No" do not contact. I also understand that in conjunction with my employment application, BHW/CVR may use the services of an outside agency to research and verify the information I have provided. This agency will provide a written report of its findings and may utilize various sources of information it deems appropriate, including but not limited to the searches listed hereafter: Identity, Criminal Records, including Criminal Conviction records, Sexual Offender/Predator, Previous Employment, including current and former employers, Military Records, Professional and Personal References. I give permission to screen, verify, and process all of the above. 
Applicant's Signature* 
Social Security Number* 
Today's Date* 
Electronic Signatures. Each party agrees that this Agreement and any other documents to be delivered in connection herewith may be electronically signed, and that any electronic signatures appearing on this Agreement or such other documents are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility
Name
This field is for validation purposes and should be left unchanged.
Black Hawk Waste Disposal & Cedar Valley Recycling and Transfer

811 Dearborn AveWaterloo, IA 50703(319)232-4150

Education

Military Service

Work History

References

Driver Authorizations

Pre-Employment Drug Testing, Drug & Alcohol, Previous Employment, and Driving Record

General consent for limited queries of the FMCSA Drug & Alcohol Clearinghouse

Drug & Alcohol Testing

Safety Performance History Records Request & MVR

General consent for limited queries of the FMCSA Drug & Alcohol Clearinghouse (DACH Authorization)

Criminal Background Check & MVR Authorization

Black Hawk Waste Disposal &
Cedar Valley Recycling and Transfer

811 Dearborn Ave
Waterloo, IA 50703
(319)232-4150
