Employment Application "*" indicates required fields 1Contact Info2Position Info3Employment History4References5Driving Experience6Acknowledgements Applicant InformationName* First Middle Last Email* Phone*Are you authorized to work in the U.S.?* Yes No Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long have you been at this address?* Other adresses over the last three (3) years?Street AddressCity/StateLength of stay? Add Remove Position DetailsDesired salary/wage?* Position applied for* Date Available* Professional Licenses and CertificationsType/NameDate Issued Add RemoveStates and license numbers for all unexpired commercial licenses and permitsStateLicense #Exp. dateClass A,BEndorsements Add Remove Employment HistoryPrevious EmploymentPlease start with your current or most recent employer Company Name Position Dates employed Actions Edit Delete There are no Employers. Add Employer Maximum number of employers reached. ReferencesPlease list at least 3 professional references Name Company Relationship Actions Edit Delete There are no References. Add Reference Maximum number of references reached. Driving ExperienceATTENTION: If you hold a CDL, you must provide COMMERCIAL DRIVING EXPERIENCE for the past 10 years.Driving Experience Equipment Class Dates (From) Dates (To) Approximate # of miles TOTAL Actions Edit Delete There are no Driving Experiences. Add Driving Experience Maximum number of driving experiences reached. Accident/Crash HistoryInclude at least the last 3 years.Accident/Crash DetailsDateNature of Accident (Backing, Head-on, Rollover, Turning)FatalitiesInjuries Add RemoveMoving Traffic Conviction and ForfeituresInclude at least the last 3 years.Traffic Convictions and ForfeituresDateOffenseLocationType of Vehicle Operated Add RemoveHave you ever been denied a license, permit or privilege to operate a motor vehicle?* Yes No If yes, please explain.*Has any license, permit or privilege ever been revoked/suspended?* Yes No If yes, please explain.*The company requires all employees who drive Commercial Motor Vehicles (CMV) which require a Commercial Driver’s License (CDL), to be controlled substances tested with a negative result prior to driving. Do you consent to such testing?* Yes No Certification and AcknowledgementsPlease read each statement closely and check the box next to the title, acknowledging your understanding. If clarification is needed, please contact Human Resources.Equal Employment Opportunity Statement* This Company is committed to the principles of equal employment opportunity and is committed to make employment decisions based on merit. We are committed to complying with all Federal, State and local laws providing for equal employment opportunities, as well as all laws related to terms and conditions of employment. The Company desires to maintain a work environment that is free of sexual harassment and discrimination due to race, religion, color, national origin, physical or mental disability, age or any other status protected by Federal, State or local laws. The Company will make reasonable efforts to accommodate those physical or mental limitations of an otherwise qualified employee unless undue hardship would result for the company.Discrimination and Harassment Policy Statement and Acknowledgment* If you are offered a position with the Company, you may be given a drug test as a condition of employment. Your refusal to timely submit to a drug test or your failure to pass such a test means you will not be employed by this company. Negative test results are required as a condition of employment.Disclosure to Applicants Concerning Drug Testing* This Company is committeThis Company strictly prohibits and does not tolerate unlawful harassment against employees or applicants because of race, color, religion, national origin, sex, age, physical or mental disability or any other characteristic protected under applicable federal, state or local law. Any employee who engages in unlawful discrimination or sexual harassment will be subject to appropriate discipline, up to and including termination. to the principles of equal employment opportunity and is committed to make employment decisions based on merit. We are committed to complying with all Federal, State and local laws providing for equal employment opportunities, as well as all laws related to terms and conditions of employment. The Company desires to maintain a work environment that is free of sexual harassment and discrimination due to race, religion, color, national origin, physical or mental disability, age or any other status protected by Federal, State or local laws. The Company will make reasonable efforts to accommodate those physical or mental limitations of an otherwise qualified employee unless undue hardship would result for the company.Post-Hire, Pre-employment Testing* If offered a position with the Company, I understand that I may be asked to undergo legally permitted physical, psychological, skill, or medical tests as a condition of employment.Background Investigation* I acknowledge that if I am offered employment with the Company, a job offer may also be contingent upon a background investigation which may include interviews with past employers, workers and friends. Said investigation may also include credit, driving, criminal background, references and other background checks.At-Will Employment* I understand and agree that if I become employed by the Company, my employment will be “at-will”, which means that the Company may terminate the employment relationship at any time, with or without cause and with or without notice. Likewise, the Company will respect my right to terminate my employment at any time, with or without cause and with or without notice. This policy does not create a contract between the Company and any person employed by the Company.Company Obligation* I understand and agree that the Company’s acceptance of this job application does not mean that a position for which I am qualified is open (unless specifically posted) or that the company has agreed to hire me. I understand that the Company is under no obligation to hire me as the result of accepting this completed application.Complete and Accurate Information* I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission of information or falsification of this application, or any other document used to secure employment, shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.Signature*This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I understand that the information in this application will be used and that prior employers may be contacted for purposes of investigation as required by 391.23 of the Federal Motor Carrier Safety Regulations.CAPTCHA
