Employment Application

DRIVER'S APPLICATION FOR EMPLOYMENT
Full Legal Name*

First NameMiddle NameLast Name
Phone Number*

Area CodePhone Number
Date

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
In compliance with Federal and State equal employment opportunity laws all qualified applicants with receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other protected status.
TO BE READ AND SIGNED BY APPLICANT

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

• Review information provided by previous employers; • Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

Signature ______________ Date ____________
FOR COMPANY USE: PROCESS RECORD

APPLICANT HIRED _________DATE EMPLOYED __________DEPARTMENT__________REJECTED __________POINT EMPLOYED ___________CLASSIFICATION ____________SIGNATURE OF INTERVIEWING OFFICER ______________
Check one

I am looking for Full time workI am Looking for Part time work
I can speak english:

FluentlyPoorlyNot at all
I am a U.S. Citizen or am authorized to work in th U.S. on an unrestricted basis:

YesNo
Have you ever been convicted of a felony? (This does not automatically exclude you from employment )

YesNo
Do you have reliable transportation?

YesNo

State All the Hours you are Available to work in the chart below.

	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
From:
To:

APPLICATION TO COMPLETE
Name
Date of Birth

____/____/_____
Current Address

________________________
Position(s) Applied for
Social Security No.
List your addresses of residency for the past 3 years

_____________________________________________
Have you worked with this company before?

Yes, where? _______No
Have you ever been bonded?

NoYes, where? ______
Do you have the legal authority to work in the United States?

YesNo
Can you perform, with or without reasonable accommodation, the essential functions of the job(as described in the attached job description)?

YesNo
Education History
High School
High School Name
High School City, State
Years Attended
Focus of Study
Graduated

YesNo
College
College Name
Years Attended
Focus of Study
Graduated

YesNo
Other Education
Other education:
Employment History
Most Recent Employer
Most Recent Employer Name
Date Started Date Ended

Dates worked for
Most Recent Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Salary
Type of work perfomed
Reason for Leaving
Supervisors Name and Position
Second Most Recent Employer
Second Most Recent Employer Name
Date Started Date Ended

Dates worked for
Second Most Recent Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Salary
Type of work perfomed
Reason for Leaving
Supervisors Name and Position
At this point in the application you are free to tell us what makes you the perfect candidate for Junk-B-Gone, if you desire.
Feel Free to upload your Resume

Upload a File

Cancelof
Please review the Pre-Employment Agreement sheet. Before Hiring you will be asked to sign.
Driving Experience
SRAIGHT TRUCK

Yes, what type of equipment? (van,tank,flat,dump,refer) From (M/Y) to (M/Y) __________ approx. no of miles ________No
TRACTOR AND SEMI-TRAILER

Yes, what type of equipment? (van,tank,flat,dump,refer) From (M/Y) to (M/Y) __________ approx. no of miles ________No
TRACTOR-TWO TRAILERS

Yes, what type of equipment?(van,tank,flat,dump,refer) From (M/Y) to (M/Y) __________ approx. no of miles ________No
TRACTOR-THREE TRAILORS

Yes, what type of equipment?(van,tank,flat,dump,refer) From (M/Y) to (M/Y) __________ approx. no of miles ________No
MOTORCOACH- SCHOOL BUS

Yes, what type of equipment?(van,tank,flat,dump,refer) From (M/Y) to (M/Y) __________ approx. no of miles ________No
ACCIDENT RECORD FOR PAST 3 YEARS OR MORE(ATTACH SHEET IF SPACE IS NEEDED)
DATES/ NATURE OF ACCIDENT/ FATALITIES/ INJURIES/ HAZARDOUS MATERIAL SPILL
LAST ACCIDENT
NEXT PREVIOUS
NEXT PREVIOUS
TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS(OTHER THAN PARKING VIOLATIONS)
LOCATION
DATE
CHARGE
PENALTY
EXPERIENCE AND QUALIFICATIONS-DRIVER(DRIVER LICENSES OR PERMITS IN THE PAST 3 YEARS)
ISSUER
LICENSE NO.
CLASS
ENDORSEMENT(S)
EXPIRATION DATE
(A)Have you ever been denied a license, permit or privilege to operate a motor vehicle?

YesNo
(B)Has any license, permit or privilege ever been suspended or revoked?

YesNo
If the answer to either A or B is YES, give details
DRIVING EXPERIENCE (CHECK YES OR NO)
Straight Truck

Yes, what kind of equipment? (VAN,TANK,FLAT,DUMP,REFER) DATES FROM (__,__) TO (__,__) APPROX. NO OF MILES _____ (TOTAL)No
Tractor and Semi-Trailer

Yes, what kind of equipment? (VAN,TANK,FLAT,DUMP,REFER) DATES FROM (__,__) TO (__,__) APPROX. NO OF MILES _____ (TOTAL)No
Tractor- Two Trailers

Yes, what kind of equipment? (VAN,TANK,FLAT,DUMP,REFER) DATES FROM (__,__) TO (__,__) APPROX. NO OF MILES _____ (TOTAL)No
Tractor- Three Trailers

Yes, what kind of equipment? (VAN,TANK,FLAT,DUMP,REFER) DATES FROM (__,__) TO (__,__) APPROX. NO OF MILES _____ (TOTAL)No
Motorcoach-School Bus (more than 8 passengers)

Yes, what kind of equipment? (VAN,TANK,FLAT,DUMP,REFER) DATES FROM (__,__) TO (__,__) APPROX. NO OF MILES _____ (TOTAL)No
Motorcoach- School Bus (more than 15 passengers)

Yes, what kind of equipment? (VAN,TANK,FLAT,DUMP,REFER) DATES FROM (__,__) TO (__,__) APPROX. NO OF MILES _____ (TOTAL)No
SHOW SPECIAL COURSES OR TRAINING THAT WILL HELP YOU AS A DRIVER
WHICH SAFE DRIVING AWARDS DO YOU HOLD AND FROM WHOM?
LIST STATES OPERATED IN FOR LAST FIVE YEARS
EXPERIENCE AND OTHER QUALIFICATIONS
SHOW ANY TRUCKING, TRANSPORTATION OR OTHER EXPERIENCE THAT MAY HELP IN YOUR WORK FOR THIS COMPANY
LIST COURSES AND TRAINING OTHER THAN SHOWN ELSEWHERE IN THIS APPLICATION
LIST SPECIAL EQUIPMENT OR TECHNICAL MATERIALS YOU CAN WORK WITH (OTHER THAN THOSE ALREADY SHOWN)
Should be Empty:

DRIVER'S APPLICATION FOR EMPLOYMENT

APPLICATION TO COMPLETE

Education History

High School

College

Other Education

Employment History

Most Recent Employer

Second Most Recent Employer

Driving Experience

ACCIDENT RECORD FOR PAST 3 YEARS OR MORE(ATTACH SHEET IF SPACE IS NEEDED)

DATES/ NATURE OF ACCIDENT/ FATALITIES/ INJURIES/ HAZARDOUS MATERIAL SPILL

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS(OTHER THAN PARKING VIOLATIONS)

EXPERIENCE AND QUALIFICATIONS-DRIVER(DRIVER LICENSES OR PERMITS IN THE PAST 3 YEARS)

DRIVING EXPERIENCE (CHECK YES OR NO)

EXPERIENCE AND OTHER QUALIFICATIONS