| Employment
Opportunities
Application for
Company Driving Positions
(Answer all questions)
In compliance with Federal and State equal
employment opportunity laws, qualified applicants
are considered
for all positions without regard to race, color,
national origin, age, marital status, or non-job
related disability. |
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Date of Applications: |
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| Name: |
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| Social Security
Number: |
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| Email: |
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| Current Address: |
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| City: |
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| State: |
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| Zip
Code: |
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| Telephone: |
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| Other
Phone: |
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Date of Birth: |
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Can you
provide proof of age?: |
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| Are you
now employed? |
Yes
No |
| If not,
how long since last employment? |
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| Have
you worked for this company before? |
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What Location? |
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| Do you have a legal right to work in
the United States? |
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| Who referred you? |
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| Rate of pay expected: |
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List your addresses of residency for
the past 3 years: |
| Previous Address: |
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| Previous Address: |
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| Previous Address: |
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| Is there any reason you might be
unable to perform the functions of the job for which
you have applied (as described)? |
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Employment History: All driver
applicants to drive intrastate or interstate
commerce must provide
the following information on all employers during
the past 10 years. List complete mailing address,
street number, city, state and zip code and all
phone numbers. Incomplete applications will not be
considered.
NOTE: List employers in reverse order starting with
the most recent. Add in the
"additional comments" section at the end if
necessary. |
| Do we have permission to contact
your "current employer"? |
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| Comments reg. contacting "current
employer": |
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| Current Employer: |
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| Dates of Employment: |
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| Company Name: |
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| Full Address: |
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| Reason for leaving: |
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| Wage/Salary: |
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| Position Held: |
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| Telephone: |
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| States you drove in: |
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| Supervisor: |
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| Number of Motor Vehicle Accidents: |
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| Types of Trailer(s) pulled: |
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| Full or Part-time: |
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| Comments: |
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| Do we have permission
to contact your "previous employer"? |
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| Comments reg.
contacting "previous employer": |
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| Current Employer: |
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| Dates of Employment: |
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| Company Name: |
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| Full Address: |
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| Reason for leaving: |
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| Wage/Salary: |
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| Position Held: |
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| Telephone: |
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| States you drove in: |
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| Supervisor: |
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| Number of Motor
Vehicle Accidents: |
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| Types of Trailer(s)
pulled: |
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| Full or Part-time: |
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| Comments: |
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| Do we have permission
to contact your "previous employer"? |
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| Comments reg.
contacting "previous employer" |
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| Current Employer: |
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| Dates of Employment: |
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| Company Name: |
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| Full Address: |
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| Reason for leaving: |
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| Wage/Salary: |
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| Position Held: |
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| Telephone: |
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| States you drove in: |
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| Supervisor: |
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| Number of Motor
Vehicle Accidents: |
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| Types of Trailer(s)
pulled: |
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| Full or Part-time: |
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| Comments: |
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| Do we have permission
to contact your "previous employer"? |
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| Comments reg.
contacting "previous employer": |
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| Current Employer: |
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| Dates of Employment: |
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| Company Name: |
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| Full Address: |
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| Reason for leaving: |
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| Wage/Salary: |
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| Position Held: |
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| Telephone: |
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| States you drove in: |
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| Supervisor: |
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| Number of Motor
Vehicle Accidents: |
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| Types of Trailer(s)
pulled: |
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| Full or Part-time: |
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| Comments: |
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| Do we have permission
to contact your "previous employer"? |
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| Comments reg.
contacting "previous employer": |
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| Current Employer: |
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| Dates of Employment: |
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| Company Name: |
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| Full Address: |
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| Reason for leaving: |
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| Wage/Salary: |
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| Position Held: |
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| Telephone: |
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| States you drove in: |
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| Supervisor: |
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| Number of Motor
Vehicle Accidents: |
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| Types of Trailer(s)
pulled: |
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| Full or Part-time: |
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| Comments: |
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| Have you ever been
discharged from a job? If yes, please list names of
companies and reason for discharge: |
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| List any companies you
applied and/or took a pre-employment or pre-driving
drug and/or alcohol test during the past two years
that is not already listed above (list company name,
date applied, and phone number): |
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| Accident report for
past 5 years (if none, write "none"), please list
dates, nature of accident (head-on, rear-end, upset,
etc.), fatalities & injuries: |
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| Traffic convictions
and forfeitures for the past 3 years (if none, write
"none"): |
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Experience and qualifications - Drivers: Drivers
Licenses (list) all drivers licenses in past 5
years, including state, license number, class,
endorsements and expiration date: |
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| A. Have
you ever had any type of motor vehicle license
suspended or revoked, or even been denied a license,
permit of privilege to operate a motor vehicle? |
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| B. Do you
have a pending charge or past convictions for
driving while intoxicated? |
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| C. Do you
have a pending charge or past conviction for
possession of a controlled substance? |
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| D. Have
you ever been refused auto liability insurance? |
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| E. Do you
have a pending charge or conviction for any
misdemeanor or felony offense? |
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The fact of a charge and/or
conviction does not automatically disqualify an
applicant from employment. |
| If the answer to
either A, B, C, D or E is yes, state all
circumstances and dates: |
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