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Trucking
Patios
Retaining Walls
Gallery
Careers
Warranty
Contact Us
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Personal Information
Last Name*
First Name*
Date of Birth*
Can you provide proof of age?*
-
Yes
No
Present Address*
How long?*
City*
State*
Zip Code*
Phone Number*
E-Mail Address*
Do you have the legal right to work in the United States?*
-
Yes
No
Must show at 3 years combined
Previous Address (If less than 3 years above)
How long?
City
State
Zip Code
Previous Address (If less than 3 years above)
How long?
City
State
Zip Code
Previous Address (If less than 3 years above)
How long?
City
State
Zip Code
Driver License and Permit Information (Past 3 years)
State*
License #*
Class*
Endorsements*
Expiration Date*
State
License #
Class
Endorsements
Expiration Date
State
License #
Class
Endorsements
Expiration Date
State
License #
Class
Endorsements
Expiration Date
State
License #
Class
Endorsements
Expiration Date
Medical Card Issuance Date*
Medical Card Expiration Date*
A) Have you ever been denied a license, permit or privlege to operate a motor vehicle?*
-
Yes
No
B) Has any license, permit or privlige ever been suspended or revoked?*
-
Yes
No
If you ansered yes to either A or B give details
Traffic Convictions and Forfeitures for the past 3 years (other than parking violations) If None, type "none"
Location*
Date
Charge
Penalty
Location
Date
Charge
Penalty
Location
Date
Charge
Penalty
Location
Date
Charge
Penalty
Desired Employment
Position*
-
Class A Driver
Class B Driver
Start Date*
Salary Desired*
Are you employed now?*
Yes
No
If not, how long since last employment?
Have you applied to this company before?*
Yes
No
When?
Ever worked for this company before?*
Yes
No
Start Date?
End Date?
Last position held?
If yes, reason for leaving
Who referred you to this company?*
-
Employment Agency
Newspaper
Radio Advertisement
Friend
ABC
Walk-in
State Employment Office
Other
Have you ever been bonded?*
-
Yes
No
Name of bonding company?
Is there an reason you might be unable to perform the functions of the job for which you are applying?*
-
Yes
No
If yes, explain if you wish
Education
School Level*
-
Grammar School
High School
College
Trade or Business School
Name & Location of School*
# Years*
Graduate?*
-
Yes
No
School Level
-
Grammar School
High School
College
Trade or Business School
Name & Location of School
# Years
Graduate?
-
Yes
No
School Level
-
Grammar School
High School
College
Trade or Business School
Name & Location of School
# Years
Graduate?
-
Yes
No
Driving Expierience
Straight Truck*
-
Yes
No
Type of Equipement
-
Van
Tank
Flat
Dump
Refer
Start Date
End Date
Approx # of Miles (Total)
Tractor and Semi-trailer*
-
Yes
No
Type of Equipement
-
Van
Tank
Flat
Dump
Refer
Start Date
End Date
Approx # of Miles (Total)
Tractor - Two Trailers*
-
Yes
No
Type of Equipement
-
Van
Tank
Flat
Dump
Refer
Start Date
End Date
Approx # of Miles (Total)
Tractor - Three Trailers*
-
Yes
No
Type of Equipement
-
Van
Tank
Flat
Dump
Refer
Start Date
End Date
Approx # of Miles (Total)
Motorcoach - School Bus (more than 8 passengers)*
-
Yes
No
Start Date
End Date
Approx # of Miles (Total)
Motorcoach - School Bus (more than 8 passengers)*
-
Yes
No
Start Date
End Date
Approx # of Miles (Total)
Other
Type of Equipement
Start Date
End Date
Approx # of Miles (Total)
List states Operated in for last five year
Special Courses or training that will help you as a driver?
Which drive safe awards do you hold?
Show any trucking, transportation, or other expierience that may help in your work for this company
List courses and training other than shown elsewhere in this application
List special equipment or technical materials you can work with (other than those already shown)
Former Employers (starting with most recent)
Name of previous employer*
Address*
City*
State*
Zip*
Start Date*
End Date*
Job Title*
Weekly Starting Pay*
Weekly Ending Pay*
May we contact your supervisor?*
-
Yes
No
Name of last supervisor*
Title*
Phone Number*
Description of work*
reason for leaving*
Were 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
Name of previous employer
Address
City
State
Zip
Start Date
End Date
Job Title
Weekly Starting Pay
Weekly Ending Pay
May we contact your supervisor?
-
Yes
No
Name of last supervisor
Title
Phone Number
Description of work
reason for leaving
Were 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
Name of previous employer
Address
City
State
Zip
Start Date
End Date
Job Title
Weekly Starting Pay
Weekly Ending Pay
May we contact your supervisor?
-
Yes
No
Name of last supervisor
Title
Phone Number
Description of work
reason for leaving
Were 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
** Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requireming 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 a whicle: (1) weighs or has a GVWR of 10,001 punds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.
References (Three not related to you, whom you have known at least 1 year)
Name*
Phone Number*
Business or relationship*
Years known*
Name*
Phone Number*
Business or relationship*
Years known*
Name*
Phone Number*
Business or relationship*
Years known*
Military Service Record
Branch of Service
Discharge Date
Rank
Branch of Service
Discharge Date
Rank
Criminal Record
Have you been convicted of a felony within the last 5 years?*
Yes
No
If yes, please explain (will not necessarily exclude you from consideration)
Signature
Authorization*
“I certify that the facts in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for termination of employment.
I authorize investigation of all statements contained herein and the references and employers listed above to give you and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by and authorized company representative.”
I agree
Electronic Signature Agreement*
"I am allowing my application to be submitted electronically"
I agree
Full Legal Name*
Date Signed*
Resume (DOC or PDF)
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