Clone of LWT Truck Driver Application

CREW MEMBER APPLICATION

Please give complete answers to ALL questions - Incomplete answers will only slow, or stall the application and our goal is to get you hired quickly.

Thank you CREW MEMBER - No matter WHO you HAUL for!

Full Name*

First NameMiddle NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Were you at this address 3 years or more.

YesNo

Please list prior 3 year addresses here and please be complete

Date of Birth*

MonthDayYear

Phone Number*

Area CodePhone Number

E-mail*

Have you ever been known by any other name?

YesNo

Please list name

Explain ie; maiden name, name change

If hired, can you show proof you are eligible to work in the U.S.?*

YesNo

Are you at least 21 years of age or older?*

YesNo

Shift Applying For (Day / Afternoon)

Have you held a VALID US license for the past 36 months?

YesNo

License Class

License Number

State of Issue

CDL Endorsements (Not Required).

License expiration date

MonthDayYear

Expiration date of DOT physical card

MonthDayYear

Hazmat expiration date

MonthDayYear

TWIC expiration date

MonthDayYear

Please list any licenses held in other states for the previous 5 years, include license numbers if you can.

Have you been to truck driving school?

YesNo

School information

School Name

Dates of attendance

CityState / Province

GPA if availableCountry

School phone number

Area CodePhone Number

Did you graduate?

YesNo

Must include past 10 years of employment.

Have you worked for Valor Junk Removal in the past?*

YesNo

Start Date

MonthDayYear

End Date

MonthDayYear

Please list current, or most recent employment first.

Start date*

MonthDayYear

Ending date*

MonthDayYear

Employer Name*

City, State*

Employer phone*

Area CodePhone Number

Position Held*

Reason for leaving*

Is this your current employer?*

YesNo

May we contact this employer at this time?*

YesNo

Was this a driving position?

YesNo

Type of truck

Number of states driven

NEXT EMPLOYER

Start date

MonthDayYear

Ending date

MonthDayYear

Employer Name

City, State

Position Held

Reason for leaving

Employer phone

Area CodePhone Number

Was this a driving position?

YesNo

Type of truck

Number of states driven

NEXT EMPLOYER

Starting date

MonthDayYear

Ending date

MonthDayYear

Employer Name

City, State

Position Held

Employer phone

Area CodePhone Number

Reason for leaving

Was this a driving position.

YesNo

Type of truck driven

Number of states driven

NEXT EMPLOYER

Start Date

MonthDayYear

End Date

MonthDayYear

Employer Name

City and State

Position

Employer Phone

Area CodePhone Number

Reason for leaving

Was this a driving position.

YesNo

Type of truck driven

Number of states driven

NEXT EMPLOYER

Start Date

MonthDayYear

End Date

MonthDayYear

Employer Name

City and State

Position

Employer Phone

Area CodePhone Number

Reason for leaving

Was this a driving position.

YesNo

Type of truck driven

Number of states driven

NEXT EMPLOYER

Start Date

MonthDayYear

End Date

MonthDayYear

Employer Name

City and State

Position

Employer Phone

Area CodePhone Number

Reason for leaving

Was this a driving position. .

YesNo

Type of truck driven

Number of states driven

If you need additional space for 10 years of past employment , please enter it here and include ALL information previously asked for.

Have you had any moving violations in the last 5 years?*

YesNo

If yes, please list City, County and State, month, year and nature of offense and any fines involved

Please list miles over limit for speeding

Has your license suspended ever been suspended?*

YesNo

If yes, please give date and length of supension. List reason why, city, county and state

List all details asked for

Have you had any accidents in the last 5 years?*

YesNo

If yes, please give date, explaination, city, county and state and if you received ticket/fine (amount)

Have you ever had a DUI, DWI, or OVI?*

YesNo

If yes, please list date of offense, jail time, fine and or suspension time.

We must have complete information to satisfy isusance carrier requirements.

Have you ever been convicted of a felony?*

YesNo

If yes, please give date and nature of offense, city, county, state and any fines and time served

Please list everything asked for per insurance requirements.

Have you ever been convicted of a misdemeanor?*

YesNo

If yes, please list date and nature of offense, city, county and state. also jail time, probation, or fines

Please list everything asked for per insurance requirements.

EDUCATION

Name & City/State of High School

Did you graduate/equivalent?

YesNo

Name & City/State of College

Did you graduate?

YesNo

VALOR JUNK REMOVAL LLC

Applicant Disclosure & Authorization for Background Investigation

Certification of Accuracy

I certify that I have personally completed this employment application and that all information provided is true, complete, and accurate to the best of my knowledge. I understand that any false statements, omissions, or misrepresentations may result in disqualification from employment consideration or termination of employment if discovered at a later date.

Authorization to Obtain Information

I hereby authorize Valor Junk Removal LLC and its designated agents, representatives, and consumer reporting agencies to conduct a background investigation for employment purposes, in accordance with applicable federal and state laws.

This investigation may include, but is not limited to:
*Identity verification
*Driving record / motor vehicle report (MVR)
*Criminal history records
*Employment history verification
*Education verification
*Character and professional references
*Drug and alcohol testing records, including refusal to test
*Any other information relevant to my suitability for employment

I authorize all former employers, educational institutions, law enforcement agencies, motor vehicle departments, and other persons or organizations having knowledge of my background to release such information to Valor Junk Removal LLC or its authorized agents.

Release of Liability

I release and hold harmless Valor Junk Removal LLC, its officers, employees, agents, and all information providers from any and all liability arising from the lawful gathering and use of such information for employment purposes.

Voluntary Consent

I acknowledge that this authorization is voluntary and ongoing during my application process and employment, unless revoked in writing where permitted by law. A copy or electronic version of this authorization shall be considered as valid as the original.

Choose ONE:*

I ACCEPTI DO NOT accept

By signing I agree I have read the above statements

General Information

License Information

EMPLOYMENT HISTORY

Additional Information

Additional Information

VALOR JUNK REMOVAL LLC

Applicant Disclosure & Authorization for Background Investigation