Apply Now - Smith Trucking

NAME
Name

First NameLast Name
Have you ever been known by or used another name (e.g. married or maiden name, etc.), specify name and date:
Are you 21 Years or Older?
Social Security No.
PRESENT ADDRESS
Street Address
City
State
Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com

Position
Position you are applying for:
Type of Employment Desired:
Description of Desired Position
Date Available for Work

MonthDayYear
Date
Minimum Salary Requirement
Have you ever applied for work or been employed by this company?
If yes, location and approximate date:

EMPLOYMENT HISTORY

Please tell us about your most recent employment history and/or relevant job experience.
Most Recent Employer
Company Name
Phone Number
Format: (000) 000-0000.
Street Address
City
State/ Province/ Region
Zip/ Postal Code
Country
Employed From

MonthDayYear
To

MonthDayYear
Name and Title of Supervisor
Starting Salary
Ending Salary
Position and Responsibilities
Reason for Leaving
Second Most Recent Employer
Company Name
Phone Number
Format: (000) 000-0000.
Street Address
City
State / Province / Region
ZIP / Postal Code
Country
Employed From

MonthDayYear
To

MonthDayYear
Name and Title of Supervisor
Starting Salary
Ending Salary
Position and Responsibilities
Reason for Leaving

REFERENCES

Please List References Not Employed by This Company
Name
Address
Phone Number
Format: (000) 000-0000.
BACKGROUND
Have you ever been convicted of a criminal offense?
If yes, please explain:
If hired, would you be able to present evidence of your US citizenship or proof of your legal right to work in the U.S.?

DOT / PRE-EMPLOYMENT
Do you have a driver's license at present?
License State
License Type
Driver's License No.
Expiration Date

MonthDayYear
Birth Date

MonthDayYear
Have you been involved in any motor vehicle accidents while driving in the last three years?
If yes, explain.
List all prior convictions for driving while intoxicated, reckless driving or possession of non-prescription drugs.
List all violations of motor vehicle laws or ordinances for which you were convicted in the last three years (excluding parking violations)
Have you ever had a license, permit or privilege to operate a motor vehicle suspended, revoked or denied?
If yes, explain.

AUTHORIZATION FOR THE RELEASE OF PERSONAL DATA AND RECORD INFORMATION

As a condition of my employment with the Company, I understand that I must undergo and pass, the Company's satisfaction, a thorough background investigation and post-hire physical examination, including a drug/alcohol screen. I hereby authorize and request that any of the information listed below be provided to the Company. A photocopy of this authorization may be treated with the same authority as the original. This certified 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
Date

MonthDayYear
In connection with my application for employment for you, I understand that a consumer report on me will be requested and used for the purpose of evaluating me for employment. In additional, if I am hired, I understand that future consumer reports may be requested and used for purposes of evaluating me for promotion, reassignment or retention as an employee. I hereby consent to you obtaining such report(s).
Signature
Date

MonthDayYear
ACKNOWLEDGEMENTS

Please read and initial each of the following:
I certify that all statements I have made in this application are true and agree that any misrepresentation or omission of facts requested may be sufficient cause for cancellation of my application or immediate dismissal from the Company if I have been employed. In the event that I am employed, I agree to conform to the rules and policies of the Company. I understand that these rules and policies may be changed, interpreted, withdrawn, or added to at the Company's option at any time without notice.
I understand that employment is contingent upon meeting the physical requirements of the job and passing, to the Company's satisfaction, a drug screen. Depending upon the nature of the job for which I am applying, I understand that the satisfactory completion of post-hire physical examination may also be required.
I acknowledge the Company's notification to me that a background investigation or an investigative consumer report on me may be made. I understand and agree that successful completion to the Company's satisfaction of such investigation(s) is required for employment or continued employment. I hereby authorize the Company to conduce or have conducted the investigation(s) described above and to prepare or cause to be prepared a report based on such information. I further understand that, upon my written request, a complete disclosure of the nature and scope of the investigation(s) conducted will be provided to me.
I agree that the Company's liability to me for wages is limited to the amount earned by me as of the date of such termination. I also authorize the Company to deduct at any time any monies owed by me to the Company whenever such deduction is not prohibited by law.
I understand that federal law prohibits the employment of unauthorized aliens and that all persons hired must submit satisfactory proof of employment authorization and identity generally within three days of being hired. I further understand that the failure to submit such proof within the required time will result in immediate dismissal from the Company if I have been employed.
I understand that my disclosure of prior convictions for criminal or traffic offenses will not necessarily prevent my employment with the Company; however, the omission of this requested information will be sufficient cause for cancellation of my application or my immediate dismissal from the Company.
I have read and agree to the above acknowledgements.
Signature
Date

MonthDayYear
Should be Empty:

NAME

PRESENT ADDRESS

Position

EMPLOYMENT HISTORY

Most Recent Employer

Second Most Recent Employer

REFERENCES

BACKGROUND

DOT / PRE-EMPLOYMENT

AUTHORIZATION FOR THE RELEASE OF PERSONAL DATA AND RECORD INFORMATION

ACKNOWLEDGEMENTS