7G Driver Employment Application

I authorize 7G to make such investigations and inquiries of my personal, employment, financial, or medical history and other related matters as may be necessary in arricing at an employment decision. (Generally, inquiries 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 inquiries and releasing information in connection with my application.

In the event of employment, I understand that fals or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of 7G Distributing, LLC.

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 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

MonthDayYear

Position applied for:*

Name:*

First NameMiddle InitialLast Name

Social Security Number:*

Date of Birth:*

MonthDayYear

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

How long at this residence?*

Primary Phone Number:*

E-mail Address:*

Please upload Resume/CV

Upload a File

Not Required

Do you have a valid Driver's License?*

YesNo

Do you have a valid CDL?*

YesNo

Can you legally work in the US?*

YesNo

Can you provide proof of age?*

YesNo

Can you provide proof of age?*

YesNo

Have you worked for 7G before?*

YesNo

Are you willing to take a physical examination by a physician, to prove you are physically able to perform the tasks of the job for which you have applied?*

YesNo

Are you able to frequently lift up to 160 pounds during the day as the job requires?*

YesNo

Have you ever been convicted, pled guilty, or pled “no contest” to a misdemeanor, felony, or other crime? If you were charged but charges were dropped or you were acquitted or the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential, answer “no”. *

YesNo

If you answered "YES" to the above question, please provide additional details

How were you referred to us?*

I would like to express my interest tin the following positions. I understand that these positions may not be available at this time.

Please list any employees presently working at 7G that you know:

Desired type of employment:*

Desired Salary (yearly):*

Are you eligible to work in the U.S.?*

YesNo

Are you age 18 or over?*

YesNo

Are you presently employed?*

YesNo

Have you ever been bonded?*

YesNo

Name of Bonding Company:

Answer only if a job requirement

Highest Level of Education:*

Name of School*

Address*

Street Address

Street Address Line 2

CityState / Province

From:*

MonthDayYear

To:*

MonthDayYear

Did you graduate?*

YesNo

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceeding 3 years. List complete mailing address, street number, city, state, and zip code.

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle.

(NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)

May we contact your present employer?*

YesNo

1. Name of Employer*

Current or most recent employer

Are you currently employed here?*

YESNO

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Dates employed (FROM)*

Dates employed (TO)*

Salary Start*

End*

Position Title*

Phone Numer*

Supervisor's Name*

Supervisor's Title*

Were you subject to the FMCSRs while employed?*

YesNo

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?*

YesNo

Describe major duties and accomplishments*

Reason for leaving*

2. Name of Employer*

Are you currently employed here?*

YESNO

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Dates employed (FROM)*

Dates employed (TO)*

Salary Start*

End*

Position Title*

Phone Numer*

Supervisor's Name*

Supervisor's Title*

Were you subject to the FMCSRs while employed?*

YesNo

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?*

YesNo

Describe major duties and accomplishments

Reason for leaving

3. Name of Employer*

Are you currently employed here?*

YESNO

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Dates employed (FROM)*

Dates employed (TO)*

Salary Start*

End*

Position Title*

Phone Numer*

Supervisor's Name*

Supervisor's Title*

Were you subject to the FMCSRs while employed?*

YesNo

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?*

YesNo

Describe major duties and accomplishments*

Reason for leaving*

OTHER QUALIFICATIONS: Summarize special job-related skills and qualifications acquired from employment or other experience.

Have you been in a motor vehicle accident in the past three years?*

YesNo

If you answered yes, please write in the Date(s), Nature of Accident(s) (Head-on, Rear-end, Upset, Etc.), Injuries, Fatalities, Hazardous Material Spill

List any Traffic Convictions and Forfeitures for the past three years (excluding parking violations). If none, write NONE.

Experience and Qualifications - Driver

Drivers licenses or permits held in the past 3 years

State:*

License Number:*

Class:*

Endorsment(s)*

Expiration Date:*

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?*

YesNo

Has any license, permit or privilege ever been suspended or revoked?*

YesNo

If the answer to either of the above questions was yes, please give details:

Driving Experience

Check yes or no on the below if you have experience in any of these areas.

Straight Truck*

YesNo

Tractor & Semi Trailer*

YesNo

Tractor - Two Trailers*

YesNo

Tractor - Three Trailers*

YesNo

Motorcoach - School Bus - More than 8 Passengers*

YesNo

Motorcoach - School Bus - More than 15 Passengers*

YesNo

List states operated in for the last five years:*

Do you hold any safe driving awards, and if so, from whom?

List any trucking, transportation or other experience that may help in your work for this company:

APPLICANT'S STATEMENT

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment, including inquiries of my personal background/driving record, employment, financial and/or medical history and other related matters as may be necessary in arriving at an employment decision.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with 7G Distributing, LLC., is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specially acknowledged in writing by an authorized executive of 7G Distributing, LLC.

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 required to abide by all rules and regulations as stated in the Employee Handbook.

Signature*

Date*

MonthDayYear