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Employment Application
Please complete the form below to apply for a position with us. Our Address: 1695 Electric Ave. Suite B Springdale, AR 72764
Our Address: 1695 Electric Ave. Suite B, Springdale, AR 72764
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Please select this to acknowledge that you have seen our address.
Check which position you are applying for:
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Office
Car Service
CDL Driver
Maintenance
Are you seeking Full-time or Part-time?
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Full-time
Part-time
Referred By:
Full Name
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First
Last
Date of Birth
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Social Security Number:
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Cell Phone:
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Format: (000) 000-0000.
Email Address
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example@example.com
Current Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Prior Address
Do you currently have a REAL ID?
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Yes
No
List Type of License(s) and Endorsements: All licenses held in the past 3 years must be listed.
Did you attend college?
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Yes
No
Currently attending
If yes, where and what degree(s) did you obtain?
Are you a citizen of the United States?
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Please Select
Yes
No
If no, are you authorized to work in the U.S.?
Please Select
Yes
No
Have you ever worked for Pinnacle Car Service, Inc.?
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Please Select
Yes
No
If yes, when?
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Month
-
Day
Year
Date
Have you ever been convicted of a felony?
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Please Select
Yes
No
If yes, when?
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Month
-
Day
Year
Date
Drivers License Number:
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Expiration Date:
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Do you have a passenger endorsement?
Yes
No
Do you have a current DOT Medical Certificate?
Yes
No
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
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Yes
No
Has any license, permit, or privilege ever been suspended or revoked?
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Yes
No
40.25(i) Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did you not obtain, safety sensitive transportation work covered by DOT Agency drug/alcohol testing rules during the past 2 years ?
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Yes
No
If you answered "YES" to the 40.25(i) question, can you provide/obtain proof that you've successfully completed the DOT return-to-duty requirements?
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Yes
No
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EQUIPMENT EXPERIENCE
PRIOR ACCIDENTS, TRAFFIC CONVICTIONS, AND REVOCATIONS
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Current and Prior Employment History
(CDL drivers must list minimum 10 years of history, Non-CDL applicants list 3 years of history)
Company
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Supervisor's Name
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Address/City/State:
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Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Position Held:
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Dates you held the position:
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Salary:
Reason for Leaving:
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Were you subject to the Federal Motor Carrier Safety Regulations while employed with this previous employer?
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Yes
No
Was this position designated as a safety sensitive function in any DOT regulated mode and were you subject to alcohol and controlled substance testing as requirements required by 49 CFR part 40?
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Yes
No
Company
Supervisor's Name
Address/City/State:
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Salary:
Position Held:
Dates you held the position:
Reason for Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations while employed with this previous employer?
Yes
No
Was this position designated as a safety sensitive function in any DOT regulated mode and were you subject to alcohol and controlled substance testing as requirements required by 49 CFR part 40?
Yes
No
Company
Supervisor's Name
Address/City/State:
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Salary:
Position Held:
Dates you held the position:
Reason for Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations while employed with this previous employer?
Yes
No
Was this position designated as a safety sensitive function in any DOT regulated mode and were you subject to alcohol and controlled substance testing as requirements required by 49 CFR part 40?
Yes
No
Company
Supervisor's Name
Address/City/State:
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Salary:
Position Held:
Dates you held the position:
Reason for Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations while employed with this previous employer?
Yes
No
Was this position designated as a safety sensitive function in any DOT regulated mode and were you subject to alcohol and controlled substance testing as requirements required by 49 CFR part 40?
Yes
No
Company
Supervisor's Name
Address/City/State:
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Salary:
Position Held:
Dates you held the position:
Reason for Leaving:
Were you subject to the Federal Motor Carrier Safety Regulations while employed with this previous employer?
Yes
No
Was this position designated as a safety sensitive function in any DOT regulated mode and were you subject to alcohol and controlled substance testing as requirements required by 49 CFR part 40?
Yes
No
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Professional References
Please list three professional references below. These should be people who are unrelated to you and may have previously supervised you directly. Include their prior/current relationship to you (i.e. Mentor, Co-Worker, or Supervisor).
Name
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First Name
Last Name
Relationship
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Please Select
Mentor
Co-worker
Supervisor
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Name
*
First Name
Last Name
Relationship
*
Please Select
Mentor
Co-worker
Supervisor
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Name
*
First Name
Last Name
Relationship
*
Please Select
Mentor
Co-worker
Supervisor
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
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Applicant Availability
Please fill the form to the best of your ability.
What Days are you Available to Work?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
If Available Monday, List Hours Available
If Available Tuesday, List Hours Available
If Available Wednesday, List Hours Available
If Available Thursday, List Hours Available
If Available Friday, List Hours Available
If Available Saturday, List Hours Available
If Available Sunday, List Hours Available
Submit
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