APPLICATION FOR EMPLOYMENT VEHICLE OPERATOR

Size: px
Start display at page:

Download "APPLICATION FOR EMPLOYMENT VEHICLE OPERATOR"

Transcription

1 NOTICE TO ALL APPLICANTS: Marvin Windows and Doors has a drug testing policy that requires drug testing as part of the post-conditional offer process for all applicants extended a conditional offer of employment. Please complete this application in its entirety. Your opportunity for employment with Marvin Windows and Doors will depend upon the completeness and accuracy of information on this form. P.O. Box 100, Warroad, MN APPLICATION FOR EMPLOYMENT VEHICLE OPERATOR PLEASE PRINT PLAINLY Date Name Last First Middle Home No. ( ) Cell No. ( ) address: Previous addresses in the last (7) years beginning with present address: Mailing address Length of Time Previous address Length of Time Previous address Length of Time Previous address Length of Time Previous address Length of Time How did you learn about employment opportunities at Marvin Windows and Doors? Have you applied for employment at Marvin previously? Yes No If yes, when? Have you worked for us before? Yes No If yes, when? If hired, on what date will you be available to start work? If hired, can you furnish proof that you are 21 years of age or older? Yes No Date of Birth (Required for Commercial Driver) If hired, can you provide proof that you can legally work in the United States? Yes No

2 Education Type of School Name, City, State, and Zip Code Years Completed High School Graduated Yes/No Major GPA College Post Graduate Business or Trade Other GED References Name and Occupation Street Address, City, State, Zip Code Phone Number Employment History All applicants to drive a commercial motor vehicle* in intrastate and/or interstate commerce must provide the following information on all employers during the preceding ten(10) years: (List employers in reverse order starting with the present or most recent) testing requirements of 49 CFR Part 40? Yes No testing requirements of 49 CFR Part 40? Yes No testing requirements of 49 CFR Part 40? Yes No

3 Prior Work History (List in order with present employer first) * Includes vehicle shaving GVWR 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 GVWR of pounds or more, (2) is designed or used to transport 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

4 Violations: Provide a true and complete list of violations (other than parking violations)for which you have been convicted or forfeited bond or collateral during the past three (3) years. Date Offense Location Type of Vehicle Operated Check here if you have not been convicted forfeited bond or collateral on account of any violation required to be listed during the past three (3) years. Accident Record: Provide accident record for the past three (3) years or more (attach sheet if more space is needed): if none, write none. Dates Last Accident Nature of Accident (Head-on, Rear-end, Upset, etc.) Fatalities Injuries Hazardous Material Spill Licenses: List all driver licenses or permits held in the past three (3) years and, if applicable, any other unexpired driver licenses or permits. State License No. Type Expiration Date Driver Licenses A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No B. Has any license, permit or privilege to operate a motor vehicle ever been suspended or revoked? Yes No If the answer to either A or B is yes, give details: Please attach official copies (MVRs) of your driving record from the appropriate agencies of each state in which you have held a motor vehicle operator s license or permit for the last three (3) years

5 MARVIN-1~ Windows ;,nd Doors Built around you: Disclosure and Release of Information Authorization NOTE: The following information, which is required for pre-employment screening purposes, IS NOT considered as part ofyour application for employment. It is used ONLYfor identification purposes, verifying information and conducting a background check. PLEASE PRINT CLEARLY. Last Name First Name Street Address City Drivers License No. State of License Middle Name Date of Birth ZIP State Expires On List any other CITIES AND STATES in which you have lived or worked during the previous 7 years. List any other LAST NAMES you have used during the previous 7 years. List any other LAST NAMES under which you received your GED, high school diploma, or other degrees. I authorize Marvin Windows and Doors and Employment Screening Associates, a consumer reporting agency, to retrieve information from all personnel, educational institutions, government agencies, companies, corporations, credit reporting agencies, law enforcement agencies at the federal, state (including the Minnesota Bureau of Criminal Apprehension), or county level, or individuals, relating to my past activities, to supply any and all information concerning my background, and release the same from any liability resulting in providing such information. The information received may include, but is not limited to, academic, residential, achievement, job performance, attendance, litigation, personal history, credit reports, driving history, and criminal history records. If my prior employers and/or references are contacted, the report may include information obtained through personal interviews regarding my character, general reputation, personal characteristics and/or mode of living. If currently employed: My current employer may be contacted. YES NO I understand that a consumer report may be prepared summarizing this information, and I understand that my employment, promotion, or retention may be determined in whole or in part based on any consumer report or investigative consumer report generated by the consumer reporting agency identified above. I may request a copy of any report that is prepared regarding me and may also request the nature and substance of all information about me contained in the files of the consumer reporting agency. I understand that proper identification will be required and that I should direct my request to: Employment Screening Associates, 8040 Blue Ash Rd., Cincinnati, OH Phone: (800) I would like a copy of any report regarding me. YES NO I agree that a photocopy of this authorization may be accepted with the same authority as the original. I also agree that this release will remain in effect throughout my employment with Marvin Windows and Doors. Signature Social Security Number Date NOTARY. Currently required for Statewide Criminal Checks in AL, GA, NM, Rl, WV, and WY; sometimes required in MN depending on search. State Signature. County of My Commission Expires o n '

6 INFORMATION FOR APPLICANTS FOR DOT-COVERED POSITIONS MARVIN WINDOWS & DOORS Federal law requires applicants to indicate whether they have previously refused to be tested or received a positive test result on any pre-employment test for any other DOT employer. Please provide this information below. It is a federal offense to falsify this information. D I have NOT tested positive on a pre-employment drug test for any other DOT employer in the past three years, nor have I refused to be tested. (If so, please sign below, and complete the remainder of this form.) D Yes, I tested positive (or I refused to be tested) on a pre-employment drug test for another DOT employer in the past three years. (If so, please sign below, and do not continue.) However, if you have completed a SAP return-to-duty process, please provide us with contact information for your SAP, so that we can obtain copies of your paperwork. In this case, you can continue with our application process. Signature of Applicant Date Each applicant for a DOT-covered position at Marvin Windows & Doors, after being notified that he/she will be offered a job, must be drug tested, in accordance with federal regulations 49 CFR Part 382. If the test result is positive, or if the applicant refuses to submit to a preemployment test, the job offer will be withdrawn. We must have a negative test result in our file before we can request or allow an employee to perform safety-sensitive functions for us. The cost of the initial screening test and the confirmatory test will be paid by Marvin. Every applicant who provides a positive test result will have an opportunity to speak with a Medical Review Officer about any recent use of prescription and non-prescription drugs that might explain the positive test result. An applicant whose test result is positive may, within 72 hours, request a test of the split specimen, at his/her own expense. The test will be conducted on the split of the original sample, and mu st be conducted by a different DI-U-IS-certified testing laboratory. I have not tested positive (or refused to be tested) on a DOT pre-employment drug test, at any time in the previous three years. (If I have, I have also completed a SAP return-to-duty process.) My signature below means that I have read this information, that I have had an opportunity to review a copy of Marvin's drug and alcohol testing policy. and that if I am offered a position, I understand that I must be tested for drugs as a condition of employment. Signature of Applicant

7 Truck Driver Job Function Work as a truck driver generally involves physical activities such as: sitting 80% of the time; performing repetitive hand, wrist and arm motions; lifting, pulling or pushing up to 80 pounds unassisted frequently, and up to 300 pounds with assistance frequently; bending, stooping, twisting and turning; climbing stairs, ladders and working in elevated areas; and standing on concrete for 10 hours while working in the plant. Are you able to perform the essential functions of the job (as described above) with or without reasonable accommodation? Yes No Section of the Federal Motor Carrier Regulations states that a person shall not drive a motor vehicle unless he/she is physically qualified to do so. Experience and Qualifications CLASS OF EQUIPMENT CIRCLE TYPE OF EQUIPMENT Straight Truck Yes No (Van, Tank, Flat, Dump, Refer) Tractor and Semi-Trailer Yes No (Van, Tank, Flat, Dump, Refer) Tractor - Two Trailers Yes No (Van, Tank, Flat, Dump, Refer) Tractor - Three Trailers Yes No (Van, Tank, Flat, Dump, Refer) Motorcoach - School Bus (more than 15 passengers) Yes No Other - - DATES FROM (M/Y) TO (M/Y) APPPROX. NO. OF MILES (TOTAL) List states operated in for the last five (5) years: List any experiences in operating a motor vehicle, including the type of vehicle, that are not listed elsewhere in this application: Which safe driving awards do you hold and from whom? Loading Dock - List type of loading dock experience and length of experience: List platform equipment you can operate (lift trucks,etc.): Truck Maintenance - List type of truck maintenance and length of experience: Training - List courses and training other than shown else where in this application: List special equipment or technical materials you can work with (other than those already shown): If you first began operating a commercial motor vehicle after, July 20, 2003 have you received a training certificate or diploma certifying compliance with the FMCSR, and in particular,49 CFR ? Yes No

8 Use the space below to provide any additional information. Applicant s Certification and Acknowledgment I certify that the information contained in this application is true and complete to the best of my knowledge. I understand that any false statement, intentional omission or misrepresentation on this application or at any time in the hiring process is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by Marvin Windows and Doors. I hereby authorize Marvin Windows and Doors and its agents, to the extent permitted by law, to investigate all statements contained in my application, resume, and otherwise provided during the hiring process and to solicit information regarding my current and former employment, education, character, and general reputation. I authorize my current and former employers, references, and relevant parties to disclose such information to Marvin Windows and Doors, and I voluntarily and knowingly fully release and hold harmless any person or organization that provides such information from any and all claims, demands, or liabilities arising out of or related to the investigation, disclosure, or use of such information. I hereby authorize Marvin Windows and Doors to seek information about my alcohol and controlled substance history and safety performance history as required by 40 CFR (d) and (e). I understand that I have the right to review information by previous employers, have errors in the information corrected by previous employers and to re-send the corrected information to the prospective employer, and to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and I cannot agree on the accuracy of the information. I understand and agree that nothing obtained in this application, or conveyed during any interview, is intended to create a contract, offer, or promise of employment. I further understand and agree that if I am hired, my employment will be at will and without fixed term, and may be terminated at any time, with or without prior notice, at the option of either myself or Marvin Windows and Doors. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Marvin Windows and Doors unless made in writing by an authorized Marvin Windows and Doors officer or official. I understand that, should I receive a conditional employment offer, such offer may be conditioned on my successful completion of a background check, credit check, physical examination, and/or alcohol and drug screening, as permitted by local, state, and federal law. I consent to such inquiries, examinations, and tests, and I request the results of such tests and examinations to be disclosed to Marvin Windows and Doors, as permitted by law. I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States. I agree that if employed, I will abide by all Marvin Windows and Doors work rules, policies, and procedures. I understand that Marvin Windows and Doors reserves the right to revise its policies or procedures, in whole or in part, at any time, with or without notice. By my continued employment, I consent to any changes. I certify and acknowledge that I have read, fully understand, and accept the above statements and terms. This application was completed by me, and all entries on it and information in it are true and complete to the best of my knowledge. Signature of Applicant Date Marvin Windows and Doors is an Equal Opportunity Employer and does not discriminate in recruitment, hiring, training, promotion, or other employment practices because of race, color, creed, religion, national origin, sex, marital status, sexual orientation, age, disability, protected veteran or military status, status with regard to public assistance, genetic information, or any other status protected by applicable federal, state, or local law. Marvin Windows and Doors will make reasonable accommodations to the known qualifying disabilities of applicants and employees when doing so will not impose an undue hardship. Applicants who believe they may need reasonable accommodation to enable them to participate in the application process should contact Human Resources

Annual Review of Driving Record

Annual Review of Driving Record Annual Review of Driving Record Motor Carrier Instructions: Each motor carrier shall at least once every 12 months, require each driver to prepare and furnish it with a list of all violations of motor

More information

Weather Shield Transportation Ltd

Weather Shield Transportation Ltd Transportation Ltd. Driver s Application for Employment Weather Shield Transportation Ltd 642 Whelen Avenue, Medford, Wisconsin 54451 In compliance with Federal and State equal employment opportunity laws,

More information

APPLICATION FOR DRIVERS

APPLICATION FOR DRIVERS 4601 TX-349 Midland,Texas 79706 (432) 617-4999 APPLICATION FOR DRIVERS You must answer every question. If any question does not apply to you, answer with Not Applicable (NA). In compliance with local,

More information

EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION of Application: EMPLOYMENT APPLICATION Email Address: What position are you applying for? Motorcoach Operator Vehicle Service Technician Mechanic Inside Sales/Customer Service Dispatcher Other: Full Name:

More information

Application for Employment Driver

Application for Employment Driver 3720 River Rd. Suite 100 Franklin Park, IL 60131 (847) 616-1080 phone (630)766-6339 fax www.rmtrucking.com email: hr@rmtrucking.com 5120 S. International Drive Cudahy, WI 53110 (414) 294-5800 phone (414)

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT APPLICANT STATEMENT I certify by my signature below that all of the information I have provided in order to apply for and secure work with the employer is true, complete and correct. I understand that

More information

DRIVER S EMPLOYMENT APPLICATION

DRIVER S EMPLOYMENT APPLICATION DRIVER S EMPLOYMENT APPLICATION Rapid Service Inc. 308 Pennsylvania Ave. Greer, SC 29650 MAP TEST LOGS HOME LOG TEST ROAD TEST In compliance with Federal and State equal employment opportunities laws,

More information

DRIVER'S APPLICATION FOR EMPLOYMENT

DRIVER'S APPLICATION FOR EMPLOYMENT DRIVER'S APPLICATION FOR EMPLOYMENT Applicant Name (print) Company Executive Transportation/Airport Shuttle/Charter of Application Address City State Zip Email: In compliance with Federal and State equal

More information

Employment Application

Employment Application Employment Application You MUST answer every question. If any question does not apply to you, answer with Not Applicable (NA). Name: Last First Middle Initial Social Security No. Address: Length of residency:

More information

Thomas Transport Delivery: APPLICATION FOR DRIVERS

Thomas Transport Delivery: APPLICATION FOR DRIVERS Thomas Transport Delivery: APPLICATION FOR DRIVERS You Must answer every question. If any question does not apply to you, answer with Not Applicable (NA). In compliance with local, state, and federal equal

More information

. Union Environmental, LLC Driver Minimum Qualifications

. Union Environmental, LLC Driver Minimum Qualifications . Union Environmental, LLC Driver Minimum Qualifications Please check each qualification you meet. All applicants must meet or exceed the following standards: Minimum age 24 2 years verifiable tractor/trailer

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT 6003 STATE ROAD 76, OSHKOSH, WI 54904 APPLICATION FOR EMPLOYMENT In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard

More information

Truck Driver Application for Employment

Truck Driver Application for Employment Truck Driver Application for Employment NAME Last First Middle LIST YOUR ES OF RESIDENCY FOR THE PREVIOUS THREE (3) YEARS. CURRENT Street City ( ) State Zip Code Telephone How Long? (yr./mo.) PREVIOUS

More information

Last Name First Name MI Social Security Number. City State Zip Code Home Phone. Previous Address (if less than 3 years at the above address)

Last Name First Name MI Social Security Number. City State Zip Code Home Phone. Previous Address (if less than 3 years at the above address) EMPLOYMENT APPLICATION DOT DRIVERS 701 24 th Avenue Southeast Minneapolis, MN 55414 Phone: (612) 623-1200 Fax: (612) 623-9108 Murphy Warehouse Company does not discriminate in hiring or employment on the

More information

SANILAC COUNTY ROAD COMMISSION EMPLOYMENT APPLICATION FOR CDL POSITION 35 N. Flynn Street Sandusky, MI 48471

SANILAC COUNTY ROAD COMMISSION EMPLOYMENT APPLICATION FOR CDL POSITION 35 N. Flynn Street Sandusky, MI 48471 SANILAC COUNTY ROAD COMMISSION EMPLOYMENT APPLICATION FOR CDL POSITION 35 N. Flynn Street Sandusky, MI 48471 (810) 648-2185 FAX (810) 648-5810 Equal access to programs, services, and employment is available

More information

Bell Logistics Inc. Page 1 Bell Logistics, Inc. P.O. Box Old US 35 East Chillicothe, OH 45601

Bell Logistics Inc. Page 1 Bell Logistics, Inc. P.O. Box Old US 35 East Chillicothe, OH 45601 Bell Logistics Inc. Page 1 Bell Logistics, Inc. P.O. Box 91 27311 Old US 35 East Chillicothe, OH 45601 In compliance with Federal and State Equal Opportunity Laws, qualified applicants are considered for

More information

Drivers Notice of Due Process Rights and Authorization

Drivers Notice of Due Process Rights and Authorization 159 Barnstead Rd., Pittsfield, NH 03263 Drivers Notice of Due Process Rights and Authorization Applicant s name: Date of application: In accordance with Federal and State equal employment opportunity laws,

More information

Position(s) Applied for. Name Social Security No Last First Middle. How Long. How Long. How Long

Position(s) Applied for. Name Social Security No Last First Middle. How Long. How Long. How Long APPLICATION FOR 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

More information

Application for Driver

Application for Driver 48 Spiller Drive Westbrook, ME 04062 207-775-2676 Fax: 207-775-2896 Email: ccaplice@sigcoinc.com Application for Driver Personal Information Date Last Name First Name MI Address City State Zip Code Home

More information

Basin Concrete & Trucking. Dear Basin Concrete Applicant,

Basin Concrete & Trucking. Dear Basin Concrete Applicant, Dear Basin Concrete Applicant, As part of our hiring process we have provided you with this application packet for you to complete. In order to make your hiring process flow as easily as possible the guidelines

More information

DRIVER'S APPLICATION PACKET

DRIVER'S APPLICATION PACKET Physical Address Contact Information 1418 E Elgin St Phone: (208) 459-0271 Caldwell, ID 83605 Fax: (208) 459-0287 Human Resources/Recruitment Director Nick Shanley Nick@RST208.com DRIVER'S APPLICATION

More information

OLE TYME PRODUCE, INC. APPLICATION FOR EMPLOYMENT Drivers

OLE TYME PRODUCE, INC. APPLICATION FOR EMPLOYMENT Drivers OLE TYME PRODUCE, INC. APPLICATION FOR EMPLOYMENT Drivers Ole Tyme Produce, Inc. is an equal opportunity employer. All applicants will be considered without regard to race, color, religion, gender, sexual

More information

Last Name First Name Middle Initial. City State Zip

Last Name First Name Middle Initial. City State Zip PLEASE PRINT APPLICATION FOR EMPLOYMENT We consider applications for all positions without regard to race, color, religion, gender, sexual orientation, age, marital or veteran status, disability, or any

More information

APPLICATION FOR QUALIFICATION

APPLICATION FOR QUALIFICATION APPLICATION FOR QUALIFICATION Company Wynne Transport Service, Inc. 2222 N 11 th Street City Omaha State NE Zip 68110 The purpose of this application is to determine whether or not that applicant is qualified

More information

Due to Stark Transportation working around Magnetic Fields, if you have a pacemaker or defibrillator, do not apply for this job.

Due to Stark Transportation working around Magnetic Fields, if you have a pacemaker or defibrillator, do not apply for this job. 19806 Mueschke Rd. Tomball, TX 77377 Phone: 281-357-0762 Fax: 281-357-0763 Email: humanresources@starktrans.com Due to Stark Transportation working around Magnetic Fields, if you have a pacemaker or defibrillator,

More information

DRIVER S EMPLOYMENT APPLICATION Highway 60 West Lewisport, KY 42351

DRIVER S EMPLOYMENT APPLICATION Highway 60 West Lewisport, KY 42351 DRIVER S EMPLOYMENT APPLICATION 9355 Highway 60 West Lewisport, KY 42351 (Answer all questions completely. If a question does not apply, respond to the question by indicating N/A Please PRINT LEGIBLY)

More information

APPLICATION FOR QUALIFICATION

APPLICATION FOR QUALIFICATION Company FMC Transport Fax # 417-469-2599 Address P.O. Box 218 City Willow Springs State MO ZIP Code 65793 The purpose of this application is to determine whether or not the applicant is qualified to operate

More information

Driver Employment Application

Driver Employment Application Steed Bros, Inc. Driver Employment Application Steed Bros, Inc. is an Equal Opportunity Employer. In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered

More information

QLF Transportation, Inc. supports marketing and distribution of QLF products throughout the United States and portions of Canada.

QLF Transportation, Inc. supports marketing and distribution of QLF products throughout the United States and portions of Canada. Application Packet Thank you for choosing QLF Transportation, Inc. as a potential employer. We carefully evaluate each application and select the best qualified candidates for further consideration. Those

More information

Application for Employment

Application for Employment Application for Employment Date of Application Signature: _ Signature: Date: U.S. Department of Transportation requires driver applicants to state their date of birth (391.21(b)(2)). month/day/year Applicant

More information

Heartland Cooperative Services Job Application. Name: Last First Middle. Address Street. City State Zip Code Phone. Position Applied For

Heartland Cooperative Services Job Application. Name: Last First Middle. Address Street. City State Zip Code Phone. Position Applied For Heartland Cooperative Services Job Application Name: Last First Middle Address Street City State Zip Code Phone Position Applied For Days available for work Times available Special training or skills (languages,

More information

RINEHART OIL, INC. Employment Application Petroleum Transportation Driver

RINEHART OIL, INC. Employment Application Petroleum Transportation Driver RINEHART OIL, INC. Employment Application Petroleum Transportation Driver Thank you for your interest in working for Rinehart Oil. At Rinehart Oil, our mission is to provide safe, dependable and efficient

More information

Alamo Pressure Pumping, LLC

Alamo Pressure Pumping, LLC Driver Information Sheet Answer all questions PLEASE PRINT CLEARLY PLEASE SELECT ONE OF THE FOLLOWING: Company Driver Owner Operator Date of application: S.S. # First Middle Last Street State Zip Country

More information

Owner Operator Application

Owner Operator Application Owner Operator Application Name: (first) (middle) (last) Current Address: (street /city) (state, zip) (how long?) Previous Addresses: (street /city) (state, zip) (how long?) (street /city) (state, zip)

More information

Employment Application

Employment Application In compliance with Federal and State Equal Employment Opportunity (EEO) laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital

More information

DRIVER S APPLICATION FOR EMPLOYMENT

DRIVER S APPLICATION FOR EMPLOYMENT BE READ AND SIGNED BY APPLICANT I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving

More information

Test Boring Services, Inc. 181 Beagle Club Road, Washington, PA BORINGS

Test Boring Services, Inc. 181 Beagle Club Road, Washington, PA BORINGS Referred by TBS, Inc. Employee? Yes or No (Employee s Name) All statements made by applicants for employment on this application form will be checked for accuracy. We offer equal employment opportunities

More information

APPLICATION FOR QUALIFICATION

APPLICATION FOR QUALIFICATION Employee ID: PO Box 930 224 4 th Street NW, Suite 8 Devils Lake, ND 58301 phone: 701.662.6300 fax: 701.662.9296 email: employment@topshelfenergy.com APPLICATION FOR QUALIFICATION COMPLETE ALL INFORMATION

More information

Employment Application CDL Holder Federal Rd, Suite B Houston, TX

Employment Application CDL Holder Federal Rd, Suite B Houston, TX Employment Application CDL Holder 1818 Federal Rd, Suite B Houston, TX. 77015 713.330.3000 1 Date: Personal Information First Name: Last Name: Street Address: City: State: Zip Code: Home Phone: Cell Phone:

More information

Application for Employment (Drivers Only) This application is good for [180] days.

Application for Employment (Drivers Only) This application is good for [180] days. FEDERATION COOPERATIVE An Equal Opportunity Employer 108 N WATER ST BLACK RIVER FALLS, WI 54615 Application for Employment (Drivers Only) This application is good for [180] days. Applicants are considered

More information

STONY RUN ENTERPRISES

STONY RUN ENTERPRISES STONY RUN ENTERPRISES Please follow these instructions for filling out the application. 1. Please save a blank copy of the form to your computer before filling it out. 2. Fill out the full application,

More information

DOT APPLICATION FOR EMPLOYMENT

DOT APPLICATION FOR EMPLOYMENT RES America Construction, Inc. 9050 N Capital of TX Hwy, Ste 390, Austin, TX 78759 DOT APPLICATION FOR EMPLOYMENT In compliance with Federal and State equal employment opportunity laws, qualified applicants

More information

Employment Application

Employment Application Drug and Alcohol Testing Required Office use only: Location Solicited Y N Employment Application SOCIAL SECURITY No. DATE OF BIRTH / / (Birth year only required for driving jobs. PER DOT 391.21-2) NAME

More information

APPLICATION FOR EMPLOYMENT APPLICANT PROCEDURES TO BE READ AND SIGNED BY APPLICANT

APPLICATION FOR EMPLOYMENT APPLICANT PROCEDURES TO BE READ AND SIGNED BY APPLICANT Office Use Only DAC MVR REF R/T PHY D/S/R APPLICATION FOR EMPLOYMENT 7380 IH 10 EAST SAN ANTONIO, TX 78219 OFFICE PHONE: 210-662-0019 FAX: 210-572-7908 Application will remain active for 30 days. Any inquiries

More information

Check type of job(s) you are applying for: Clerical Dispatcher Part-time driver Full-time driver

Check type of job(s) you are applying for: Clerical Dispatcher Part-time driver Full-time driver APPLICATION FOR EMPLOYMENT Ripley County Transit, Inc. P. O. Box 541 ** RR2 BOX 1121 Doniphan, MO 63935 Ripley County Transit is an Equal Opportunity Employer We consider applicants for all positions without

More information

A B C Hazardous Doubles/Triples Passenger Air Brake State License NO. Class (check one) Endorsements (Check those you have now) Expiration Date

A B C Hazardous Doubles/Triples Passenger Air Brake State License NO. Class (check one) Endorsements (Check those you have now) Expiration Date 3 DRIVING EXPERIENCE AND QUALIFICATION Licenses Drivers Licenses held in the past three years must be shown. (Attach separate sheet if more space is needed.) If none, check here A B C Hazardous Doubles/Triples

More information

TO BE READ AND SIGNED BY APPLICANT

TO BE READ AND SIGNED BY APPLICANT TRUCK ONE, INC. INDEPENDENT CONTRACTOR SAFETY CLEARANCE FORM Note: Read and complete all portions of this proposal in your own handwriting (legible) in ink (Please print). Applications that are incomplete,

More information

P O Box 727 Evergreen, AL Phone (251) Fax (251) DRIVER APPLICATION FOR EMPLOYMENT

P O Box 727 Evergreen, AL Phone (251) Fax (251) DRIVER APPLICATION FOR EMPLOYMENT P O Box 727 Evergreen, AL 36401 Phone (251)-226-2611 Fax (251)-578-2360 DRIVER APPLICATION FOR EMPLOYMENT NAME Social Security # (First) (Middle) (Last) ADDRESS How Long (Street)(City) (State & Zip Code)

More information

NANCY BAER TRUCKING, INC. FAX #: (812) DATE OF APPLICATION: COMPANY: NANCY BAER TRUCKING, INC. ADDRESS:

NANCY BAER TRUCKING, INC. FAX #: (812) DATE OF APPLICATION: COMPANY: NANCY BAER TRUCKING, INC. ADDRESS: NANCY BAER TRUCKING, INC. FAX #: (812) 482-2118 DATE OF APPLICATION: COMPANY: NANCY BAER TRUCKING, INC. ADDRESS: 3137 VIRGINIA AVENUE JASPER, INDIANA 47546 In compliance with Federal and State equal opportunity

More information

Tideport Distributing, Inc De Zavala Rd Channelview, TX Phone: Fax:

Tideport Distributing, Inc De Zavala Rd Channelview, TX Phone: Fax: Tideport Distributing, Inc. 16031 De Zavala Rd Channelview, TX 77530 Phone: 281-862-9668 Fax: 281-452-2865 ALL APPLICANTS _ In accordance with Federal regulations, please fill-in this application so that

More information

CDL EMPLOYMENT APPLICATION

CDL EMPLOYMENT APPLICATION CDL EMPLOYMENT APPLICATION Saginaw County Road Commission 3020 Sheridan Avenue Saginaw, MI 48601 989-752-6140 Careful and thoughtful completion of this Application is an important step in our consideration

More information

DRIVER S APPLICATION FOR EMPLOYMENT

DRIVER S APPLICATION FOR EMPLOYMENT DRIVER S APPLICATION FOR EMPLOYMENT (Answer all questions please print) In compliance with Federal and Provincial equal employment opportunities laws, qualified applicants are considered for all positions

More information

APPLICATION FOR EMPLOYMENT *Applicant must complete in his or her own handwriting

APPLICATION FOR EMPLOYMENT *Applicant must complete in his or her own handwriting APPLICATION FOR EMPLOYMENT *Applicant must complete in his or her own handwriting Date of Application / / Social Security Number / / Applicant Name Address City _ State Zip Home Phone Cell Phone Email

More information

ALPENA COUNTY ROAD COMMISSION APPLICATION FOR EMPLOYMENT FOR CDL DRIVERS

ALPENA COUNTY ROAD COMMISSION APPLICATION FOR EMPLOYMENT FOR CDL DRIVERS ALPENA COUNTY ROAD COMMISSION APPLICATION FOR EMPLOYMENT FOR CDL DRIVERS CAREFUL AND THOUGHTFUL COMPLETION OF THIS APPLICATION IS AN IMPORTANT STEP IN OUR CONSIDERATION OF INDIVIDUALS FOR EMPLOYMENT. PLEASE

More information

Applicant Name: Last First Middle. Present Address: Street City State Zip Code. Previous Address: Street City State Zip Code

Applicant Name: Last First Middle. Present Address: Street City State Zip Code. Previous Address: Street City State Zip Code Midland Marketing Application for Employment MIDLAND MARKETING is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, creed, color, age,

More information

INDEPENDENT CONTRACTOR APPLICATION (AN EQUAL OPPORTUNITY EMPLOYER)

INDEPENDENT CONTRACTOR APPLICATION (AN EQUAL OPPORTUNITY EMPLOYER) 6550 Courtly Rd Woodbury, MN 55125 INDEPENDENT CONTRACTOR APPLICATION (AN EQUAL OPPORTUNITY EMPLOYER) POSITION(S) APPLYING FOR (circle those that apply): Owner Operator - Driver for Owner Operator - Lease

More information

In order for us to process your application in a timely manner, we need your assistance.

In order for us to process your application in a timely manner, we need your assistance. Thank you for inquiring about a driving position with RTL Round-the-Lakes Motor Express In order for us to process your application in a timely manner, we need your assistance. 1. Complete all parts of

More information

NOW Courier, Inc. COMMERCIAL DRIVER APPLICATION FILL IN ALL BLANKS & PROVIDE ALL INFORMATION REQUESTED--PRINT OR TYPE

NOW Courier, Inc. COMMERCIAL DRIVER APPLICATION FILL IN ALL BLANKS & PROVIDE ALL INFORMATION REQUESTED--PRINT OR TYPE July 2003, dlnm NOW Courier, Inc. P.O. Box 6066 Indianapolis, IN, 46206 COMMERCIAL DRIVER APPLICATION FILL IN ALL BLANKS & PROVIDE ALL INFORMATION REQUESTED--PRINT OR TYPE. Date: (317) 638-7071 Name: First

More information

DOT Employment Application

DOT Employment Application DOT Employment Application CDL Applications MUST be completed entirely. P.O. Box 729 540 S Main St. Adams, WI 53910 Phone: (608) 339-3394 PLEASE PRINT CLEARLY OR TYPE ALL CAPITAL LETTERS FOR ON-LINE APPLICATION

More information

ROCK STAFFING DRIVER APPLICATION FOR EMPLOYMENT. Name: (First) (Middle) (Last) Address:

ROCK STAFFING DRIVER APPLICATION FOR EMPLOYMENT. Name: (First) (Middle) (Last) Address: ROCK STAFFING DRIVER APPLICATION FOR EMPLOYMENT Date of application: / / Name: (First) (Middle) (Last) Address: (Street) (City) (State & Zip) How long at this address: Phone: Cell: Date of Birth: / / Social

More information

Koy Concrete, Ltd. P.O.Box 308 Sealy, TX Fax

Koy Concrete, Ltd. P.O.Box 308 Sealy, TX Fax Koy Concrete, Ltd. P.O.Box 308 Sealy, TX 77474-0308 713.319.9390 979.885.3551 Fax 713.319.9393 Qualified applications are considered for all positions without regard to race, color, religion, sex, national

More information

FIRST CHOICE OF ELKHART, INC PRELIMINARY DRIVER APPLICATION

FIRST CHOICE OF ELKHART, INC PRELIMINARY DRIVER APPLICATION FIRST CHOICE OF ELKHART, INC PRELIMINARY DRIVER APPLICATION THANK YOU FOR YOUR INTEREST! PLEASE COMPLETE ALL INCLUDED FORMS AND RETURN TO FIRST CHOICE ALONG WITH A COPY OF YOUR CLASS A CDL. PLEASE NOTE

More information

DRIVER QUALIFICATION APPLICATION

DRIVER QUALIFICATION APPLICATION VSS TRANSPORTATION GROUP 1325 W BELTLINE RD. CARROLLTON, TX 75006 TEL: 469-568-6380/ 1-800-697-0561 FAX: 888-363-9923 E-MAIL HR@VSSCARRIERS.COM DRIVER QUALIFICATION APPLICATION If you feel your civil rights

More information

Name Social Security No. Last First Middle Address. State, Zip Phone Zip ADDRESS. How Long. Do you have the legal right to work in the United States

Name Social Security No. Last First Middle Address. State, Zip Phone Zip ADDRESS. How Long. Do you have the legal right to work in the United States Arkansas Equipment Leasing Application P.O. Box 905 Mabelvale, AR 72103 In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without

More information

TPS Inc. APPLICATION FOR EMPLOYMENT

TPS Inc. APPLICATION FOR EMPLOYMENT TPS Inc. APPLICATION FOR EMPLOYMENT Assigned To: Murray Trucking, Inc. 14778 E Liverpool Rd East Liverpool, Ohio 43920 APPLICANTS ARE CONSIDERED WITHOUT REGARD TO RACE, CREED, COLOR, SEX, RELIGION, AGE

More information

WestWind Logistics, LLC

WestWind Logistics, LLC WestWind Logistics, LLC 1658 E Euclid Ave, Des Moines, IA 50313 (866) 455-1082 READ AND SIGN BEFORE SUBMITTING APPLICATION FOR QUALIFICATION I understand that the information in the Application for Qualification

More information

We are looking for drivers with at least 2 years of RECENT verifiable tractor trailer experience. Tanker and / or Crude experience is a HUGE plus!!

We are looking for drivers with at least 2 years of RECENT verifiable tractor trailer experience. Tanker and / or Crude experience is a HUGE plus!! Welcome and thank you for your interest in driving for Xcalibur Logistics! Please fill out the attached Application making sure that all sections are completed including all requested signatures and boxes

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT 12961 40th Avenue Chippewa Falls, WI. 54729 (715) 403-5599 Main number (715) 403-5598 Fax number APPLICATION FOR EMPLOYMENT Application Date Name of Driver Social Security Number Present Address City State

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT SSN Norris Towing 1108 South Lee Highway Cleveland, TN 37320 423-472-5580 www.norristowing.com APPLICATION FOR EMPLOYMENT Name: FIRST-MIDDLE-LAST (AS IT APPEARS ON SOCIAL SECURITY CARD) SOCIAL SECURITY

More information

PREVIOUS THREE YEARS RESIDENCY # OF YEARS:

PREVIOUS THREE YEARS RESIDENCY # OF YEARS: DATE: / / APPLICATION FOR EMPLOYMENT AO EXPRESS INC 200 N PHILIPS AVE STEL104 SIOUX FALLS, SD 57104 Office Use Only Interview Date: / / Hire Date: / / Start Date: / / NAME: (FIRST) (MIDDLE) (LAST) ADDRESS:

More information

Alger County Road Commission E9264 M-28 Munising, MI Phone: (906) Fax: (906) Application for Employment CDL DRIVERS

Alger County Road Commission E9264 M-28 Munising, MI Phone: (906) Fax: (906) Application for Employment CDL DRIVERS Alger County Road Commission E9264 M-28 Munising, MI 49862 (906)387-2042 Fax: (906)387-5167 Application for Employment CDL DRIVERS CAREFUL AND THOUGHTFUL COMPLETION OF THIS APPLICATION IS AN IMPORTANT

More information

CF LOGISTICS LLC. PO Box 686, Avondale, PA Phone: Fax:

CF LOGISTICS LLC. PO Box 686, Avondale, PA Phone: Fax: CF LOGISTICS LLC Form DQ-Cover1 Thank you for your interest in becoming a Professional CDL Driver with CF Logistics LLC We understand that the information you provide us on this application is very sensitive

More information

SPOERL TRUCKING Driver Application Applicant Name:

SPOERL TRUCKING Driver Application Applicant Name: SPOERL TRUCKING Driver Application Applicant Name: Return to: Spoerl Trucking, Inc W1307 Industrial Drive Ixonia, WI 53036 Fax: 262-569-7720 Email: ebeebe@spoerltrucking.com DRIVER S APPLICATION FOR EMPLOYMENT

More information

INDIANA COUNTY Employment Application

INDIANA COUNTY Employment Application INDIANA COUNTY Employment Application Mailing Address: 825 Philadelphia Street Indiana, PA 15701 Phone: 724-465-3805 Fax: 724-465-3953 Indiana County is an equal opportunity employer, dedicated to a policy

More information

Your Premier Service Provider

Your Premier Service Provider FVC Frenchman Valley Coop fvcoop.com Your Premier Service Provider 202 Broadway St., PO Box 578 Imperial, NE 69033 Updated 04/30/2013 Application for Employment Prospective employees will receive consideration

More information

The Powell Company CDL Driver s Application For Employment

The Powell Company CDL Driver s Application For Employment Signature of Applicant: The Powell Company CDL Driver s Application For Employment We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including

More information

Prisma - Employment Application

Prisma - Employment Application Prisma - Employment Application Prisma is an equal opportunity employer, dedicated to a policy of non- discrimination in employment on any basis including age, sex, color, race, creed, national origin,

More information

CALEX EXPRESS, INC 58 Pittston Avenue Pittston, PA

CALEX EXPRESS, INC 58 Pittston Avenue Pittston, PA CALEX EXPRESS, INC 58 Pittston Avenue Pittston, PA. 18640 APPLICATION FOR DRIVER POSITION In compliance with Federal and State Equal Employment Opportunity Laws, qualified applicants are considered for

More information

Application for Employment

Application for Employment Application for Employment DATE OF APPLICATION / / R. W. SIDLEY, INC. P.O. Box 150 Painesville, OH 44077 POSITIONS APPLIED FOR RATE OF PAY EXPECTED $ WEEK REFERRAL SOURCE ADVERTISEMENT EMPLOYEE RELATIVE

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT Name: FIRST-MIDDLE LAST (AS IT APPEARS ON SOCIAL SECURITY CARD) SOCIAL SECURITY NO. TODAY S DATE DATE OF BIRTH: FORMER NAME: PHONE: DRIVERS LICENSE NO. & EXPIRATION: List below all address at which you

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT Jordan Towing, Inc. 601 Digital Drive Plano, Tx. 75075 SSN TDLR NUMBER APPLICATION FOR EMPLOYMENT Name: FIRST-MIDDLE-LAST (AS IT APPEARS ON SOCIAL SECURITY CARD) SOCIAL SECURITY. TODAY'S DATE FORMER NAME

More information

United Courier INDEPENDENT CONTRACTOR DRIVER QUALIFICATION FORM

United Courier INDEPENDENT CONTRACTOR DRIVER QUALIFICATION FORM United Courier INDEPENDENT CONTRACTOR DRIVER QUALIFICATION FORM By signing below, Driver understands that the information provided on this Qualification Form will be used to determine the Applicant s qualifications.

More information

Executive Transportation Services, Inc. Employment Application Form

Executive Transportation Services, Inc. Employment Application Form Employment Application Form PLEASE PRINT ALL INFORMATION REQUESTED This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race,

More information

Applicant Instructions: If the answer to a question is no, none, or N/A, please fill in the blank accordingly. Do not leave any questions blank.

Applicant Instructions: If the answer to a question is no, none, or N/A, please fill in the blank accordingly. Do not leave any questions blank. 855 Progress Industrial Blvd. Lawrenceville, Georgia 30043 Driver Application Referred by: Please email completed forms back to: sdavis@performancetrucking.com or fax to 678-546-6878 Applicant Instructions:

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT SSN TOWING & STORAGE 3565 W. Columbus, Chicago, IL 60652 APPLICATION FOR EMPLOYMENT Name: FIRST-MIDDLE-LAST (AS IT APPEARS ON SOCIAL SECURITY CARD) SOCIAL SECURITY NO. TODAY'S DATE FORMER NAME HOME (AREA

More information

APPLICATION FOR CONTRACT SERVICES

APPLICATION FOR CONTRACT SERVICES APPLICATION FOR CONTRACT SERVICES Location applying for: Date: OWNER OPERATOR COMPANY INFORMATION This section must be filled out on the original application by the Owner Operator. Drivers for the Owner

More information

CONTRACTOR APPLICATION

CONTRACTOR APPLICATION DD&S Express, Inc. 185 Harry S Truman PKWY, Suite 116 Annapolis MD 21401 410-488-9200 Ext 1492 Fax: 301-386-0709 applications@ddsexpress.com 1 of 5 CONTRACTOR APPLICATION In compliance with Federal and

More information

If you were at the above address less than three years, list your previous address.

If you were at the above address less than three years, list your previous address. AZO Services APPLICATION FOR DRIVERS You Must Answer every question. If any question does not apply to you, answer with Not Applicable (NA) In compliance with local, state, and federal equal employment

More information

APPLICATION FOR EMPLOYMENT Crooker Construction, LLC 103 Lewiston Road, P.O. Box 5001, Topsham, Maine 04086

APPLICATION FOR EMPLOYMENT Crooker Construction, LLC 103 Lewiston Road, P.O. Box 5001, Topsham, Maine 04086 APPLICATION FOR EMPLOYMENT - 2015 Crooker Construction, LLC 103 Lewiston Road, P.O. Box 5001, Topsham, Maine 04086 Crooker Construction, LLC appreciates your interest in our organization and assures you

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT Equal Opportunity Employer APPLICATION FOR EMPLOYMENT Today s Date: Position Applying for: Full Name: Last First Middle : Street City State Zip code Phone No. Email Desired Salary $ hourly annually Work

More information

Lansberry Trucking, Inc.

Lansberry Trucking, Inc. WORK DESCRIPTION AND REQUIREMENTS TO BE AN OWNER- OPERATOR/INDEPENDENT CONTRACTOR (TRIAXLE AND OVER-THE-ROAD TRACTOR TRAILER) FOR LANSBERRY TRUCKING, INC. Be able to read and speak the English language

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT APPLICATION FOR EMPLOYMENT COMPANY STREET ADDRESS CITY, STATE AND ZIP CODE NAME (FIRST) (MIDDLE) (Maiden Name, if any) (LAST) ADDRESS HOW LONG? (STREET) (CITY) (STATE & ZIP CODE) DATE OF BIRTH SOCIAL SECURITY

More information

D Job Fair D Community Organization D Employee Referral: D Other: Employment Application Safety Sensitive Positions

D Job Fair D Community Organization D Employee Referral: D Other: Employment Application Safety Sensitive Positions Transit Management of Montgomery 2318 W. Fairview Avenue Montgomery, AL 36108 Fax: 334 262-7366 Employment Application Safety Sensitive Positions Note to Applicant: Please advise us in advance if you require

More information

Please fill out the attached application and return it to our office. Please include the following:

Please fill out the attached application and return it to our office. Please include the following: Dear Prospective Independent Contractor: We strive to inform our applicants of every detail possible before offering a contract. We find that the better informed each applicant is, the better fit our drivers

More information

DRIVER QUALIFICATION APPLICATION

DRIVER QUALIFICATION APPLICATION Agent/Terminal # Recruiter DRIVER QUALIFICATION APPLICATION Thank you for your interest in one of our Greatwide Truckload Management Carriers. Please read and complete this application. Be sure to sign

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT APPLICATION FOR EMPLOYMENT EDWARDS, Inc. EDWARDS/Greenville, Inc EDWARDS/Wilmington, Inc Employment Desired: Position Desired: This Company Is An Equal Opportunity Employer This company is subject to E-Verify

More information

COMMERCIAL DRIVER APPLICATION

COMMERCIAL DRIVER APPLICATION A1 ORGANICS 16350 WCR 76, Eaton, CO 80615 Ph 970.454.3492 Fax 970.454.3232 www.a1organics.com COMMERCIAL DRIVER APPLICATION POSITION(S) APPLIED FOR: Name Social Security Number / / Phone Date of Birth

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT Ross Baker Towing United Road Towing, Inc. 8750 Vanalden Avenue 9550 Bormet Drive Suite 301 Northridge, Ca. 91234 Mokena, IL. 60448 APPLICATION FOR EMPLOYMENT Name: FIRST-MIDDLE-LAST (AS IT APPEARS ON

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT Lupient Buick/GMC of Rochester 4646 Highway 52 North Rochester, MN 55901 Phone: (507) 288-1811 Fax: (507) 288-8819 www.lupientbgrochester.com APPLICATION FOR EMPLOYMENT An Equal Opportunity Employer We

More information

AN EQUAL OPPORTUNITY EMPLOYER/AA/ADA AND DRUG FREE

AN EQUAL OPPORTUNITY EMPLOYER/AA/ADA AND DRUG FREE P. O. Box 52488, Tulsa, OK 74152 (918) 582-2100 FAX (918) 599-7266 APPLICATION FOR EMPLOYMENT PLEASE PRINT OR TYPE NAME (FIRST, MIDDLE, LAST SOCIAL SECURITY NO.) PRESENT ADDRESS (STREET, CITY, STATE &

More information