General Employment Application Employee Application Desired Position * Desired Location * 1. Personal Information Full Name * Email Address * Home Phone * Address * City Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip 2. Employment Information Employment Desired * Full-time Part-time Seasonal Do you have the legal right to work in the United States? * Yes No Are you over the age of 18? Yes No Can you provide proof of age? * Yes No Have you ever worked this company before? * Yes No If yes, where? Dates of Employment with us? Rate of Pay and Position Reason for leaving When will you be able to begin work? How did you hear about us? Have you ever been bonded? * Yes No Name of Bonding Company Have you been convicted of a felony? * Yes No Please explain fully. Conviction of a crime is not an automatic bar to employment. All circumstances will be considered. 3. Employment History Please give accurate, complete full-time and part-time employment record for the past 7 years (if applicable). Start with your present or most recent employer. (If more than 4 employers please list additional employment in text box at end). * Includes vehicles having a GVR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding. † The Federal Motor Carrier Safety Regulations )FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a FVWR of 10,001 pounds or more, (2) is designed or used to transpoirt 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding. Most Recent/Current Employer Position Salary/Wage Dates Employed * Telephone Number Contact Person Job Title and Description Reason for Leaving Where you subject to the FMCSRS † while employed? * Yes No Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? * Yes No Previous Employer * Most recent/current job Position Salary/Wage Dates Employed * Telephone Number Contact Person Job Title and Description Reason for Leaving Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? * Yes No Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? * Yes No Previous Employer * Most recent/current job Position Salary/Wage Dates Employed * Telephone Number Contact Person Job Title and Description Reason for Leaving Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? * Yes No Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? * Yes No Attach Resume Uploading Files. Please Wait. Drop a file here or click to upload Choose File Maximum upload size: 10MB 4. Education/Skills Highest Grade Completed (Elementry) 1 2 3 4 5 6 7 8 Highest Grade Completed (High School) 1 2 3 4 Years Completed (College) 1 2 3 4 Last School Attended City, State List computer skills List Certifications/Licenses List any trucking, transportation or other experience that may help in your work for this company List courses and training other than shown elsewhere on this application List special equipment of technical materials you can work with (other than those already shown) 5. Review/Submit Your Application FORM FOR GENERAL EMPLOYMENT In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status. I authorize you to make such investigations and inquires of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading, information given in my application or interview(s) may result in discharge. I understand, also that I am required to abide by by all rules and regulations of the Company. I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to: * Review information provided by previous employers * Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer * 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. Checkboxes * I have read and agree to the above terms* VERIFY INFORMATION ABOVE Once you have verified your Employment History, you please sign below and submit you application. APPLICANT'S DIGITAL SIGNATURE PLEASE READ AND UNDERSTAND THE STATEMENT BELOW BEFORE FINALIZING YOUR APPLICATION: ~ The information I have provided in this Application for Employment is true, correct, and complete. False, incomplete, or misrepresented information of any kind will be sufficient cause for my application to be rejected or, if discovered after I am employed, cause for immediate termination. ~ I authorize the employer to contact an obtain information about me from previous employers, educational institutions, and "references" I provided, and any other party necessary to verify the accuracy of information I disclosed in the application, a related employment resume or a personal interview. To assist in the processing of my application, I waive all rights and claims I may otherwise have against the employer or its representatives, for seeking, and using information to evaluate my employment request and all other persons, corporations, or organizations who provide information for this purpose. ~ This application is not an employment agreement. If I accept an offer of employment, I understand the employer may terminate my employment at any time, with or without cause and without prior notice, unless required by law. I understand that no one, other than an executive officer of the employer, has authority to enter into any employment agreement with terms contrary to the foregoing and then only in writing signed by such officer. Type Your Name * Date Signed *