EMPLOYMENT APPLICATION

Date
Date
Name *
Name
Address *
Address
Phone *
Phone
Date Available
Date Available
$
High School Address:
High School Address:
PREVIOUS EMPLOYMENT
Give a COMPLETE RECORD of 3 most recent employers. ALL fields MUST be filled in completely.
EMPLOYER 1
Address *
Address
Phone *
Phone
Beginning Date *
Beginning Date
End Date *
End Date
EMPLOYER 2
Address
Address
Phone
Phone
Contact Name
Contact Name
Beginning Date
Beginning Date
End Date
End Date
EMPLOYER 3
Address
Address
Phone
Phone
Contact Name
Contact Name
Beginning Date
Beginning Date
End Date
End Date
REFERENCES
Please list three professional references
REFERENCE 1
Phone
Phone
REFERENCE 2
Phone
Phone
REFERENCE 3
Name
Name
Phone
Phone
Driving Experience
Please check all that apply.
Please list out the dates of your driving experience with the approximate number of miles.
Please list out: Date of Accident / Nature of Accident / Location of Accident / Number of Fatalities / Number of Injuries
Please write out: Date / Location / Charge / Penalty
State / License # / Type / Endorsements / Expiration Date
Disclaimer
It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty. It is agreed and understood that the motor carrier or his agents may investigate the applicant’s background to ascertain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his furnishing such information. It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigating Consumer Report, including information regarding my character general reputation, personal characteristics and mode of living. I agree to furnish such additional information and complete such examinations as may be required to complete my application file. It is agreed and understood that this Application in no way obligates the motor carrier to employ or hire the applicant. It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified without recourse. 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.
Signature
Signature