Employment Application
Fill the form below accurately and completely.
Personal Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Length of Time at Current Address
*
Phone Number
*
Email
*
example@example.com
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
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5
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31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
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1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Previous Address (Only if less than three years at current address).
How did you hear about Guardian Barrier Services?
*
Website
Referral
Facebook
Job Board
Instagram
Other (please specify)
If referred, referral's name
Driving Information
Driver's License
*
Please list all driver's licenses held including State / License Number / Type / Expiration
Accident Record
*
Please list all accidents for past three years including Date/ Nature of Accident/ Fatalities/ Injuries. If none, type none.
Driving Experience
*
Please list all driving experience including Class of Equipment/ Type of Equipment/ Date to & from/ Approximate Miles.
Employment History
Please list all employers from the last 5 years
Employer Name
*
Employer Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer Phone Number
Please enter a valid phone number.
Was this position under FMCSA regulations?
Please Select
Yes
No
Were you in an ACTIVE drug and alcohol testing program?
Please Select
Yes
No
Position Held
Start Date
-
Month
-
Day
Year
End Date
-
Month
-
Day
Year
Reason for Leaving
Second Employer
Employer Name
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer Phone Number
Please enter a valid phone number.
Was this position under FMCSA regulations?
Please Select
Yes
No
Were you in an ACTIVE drug and alcohol testing program?
Please Select
Yes
No
Position Held
Start Date
-
Month
-
Day
Year
End Date
-
Month
-
Day
Year
Reason for Leaving
Third Employer
Employer Name
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer Phone Number
Please enter a valid phone number.
Was this position under FMCSA regulations?
Please Select
Yes
No
Were you in an ACTIVE drug and alcohol testing program?
Please Select
Yes
No
Position Held
Start Date
-
Month
-
Day
Year
End Date
-
Month
-
Day
Year
Reason for Leaving
International Travel (NOT REQUIRED)
Do you currently have a valid passport?
Please Select
Yes
No
No, but I can obtain one
Are you able to travel into Canada in a commercial vehicle?
Please Select
Yes
No
Will be able to after successful completion of passport process.
Legal
Have you ever had any type of motor vehicle license suspended or revoked, or been denied a license, permit of privilege to operate a motor vehicle?
Please Select
Yes
No
If yes, please explain
Do you have a pending charge or past conviction for driving while intoxicated? *
*
Please Select
Yes
No
If yes, please explain
Do you have a pending charge or past conviction for possession of a controlled substance?
*
Please Select
Yes
No
Have you ever been refused auto liability insurance?
*
Please Select
Yes
No
If yes, please explain
Do you have a pending charge or conviction for any misdemeanor or felony offense?
*
Please Select
Yes
No
If yes, please explain
Application Addendum and Rights
Application Addendum
Federal Motor Carrier Safety Regulations 40.25 (j) The employer must ask the employee whether he or she has tested, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work covered by DOT drug and alcohol testing rules during the past two years.
Rights
1. The right to review information provided by previous employers. | 2. The right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to the prospective employer. | 3. The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.
*
Please Select
Accept
Decline
This certifies that I completed this application, and that all entries on it and information in it are complete to the best of my knowledge. I authorize you to make such investigations and inquire of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquires regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquires and releasing information in connections with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am to abide by all rules and regulations of the Company.
*
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
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