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Employment Application
In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex national origin, age, marital status, or non-job related disability.
Step 1 of 6
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General Information
Position(s) Applied for
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Name
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First
Last
Date of Birth
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Social Security Number
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Phone
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Cell Phone
Current Address
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List your addresses of residency for the past 3 years
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Previous Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Experience & Qualifications
Drivers Licence State
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License Number
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License Type
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License Expiration Date
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Drivers Licence State
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License Number
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License Type
*
License Expiration Date
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Drivers Licence State
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License Number
*
License Type
*
License Expiration Date
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Are you currently employed?
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Yes
No
If No, how long since leaving your last employment?
Is there any reason you might be unable to perform the function(s) or the job for which you have applied?
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Yes
No
If Yes, please explain
Employment History
All driver applicants must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, phone numbers, city, state and zip codes. 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.)
Employer
*
Start Date
*
End Date
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Position Held
*
Contact Person
*
Phone
*
Fax Number
Salary/Wage
*
Were you subject to the FMCSR's while employed?
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Yes
No
Reason for leaving
*
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?
*
Yes
No
Employer
*
Start Date
*
End Date
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Position Held
*
Contact Person
*
Phone
*
Fax Number
Salary/Wage
*
Were you subject to the FMCSR's while employed?
*
Yes
No
Reason for leaving
*
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?
*
Yes
No
Employer
*
Start Date
*
End Date
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Position Held
*
Contact Person
*
Phone
*
Fax Number
Salary/Wage
*
Were you subject to the FMCSR's while employed?
*
Yes
No
Reason for leaving
*
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?
*
Yes
No
Employer
*
Start Date
*
End Date
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Position Held
*
Contact Person
*
Phone
*
Fax Number
Salary/Wage
*
Were you subject to the FMCSR's while employed?
*
Yes
No
Reason for leaving
*
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?
*
Yes
No
Employer
*
Start Date
*
End Date
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Position Held
*
Contact Person
*
Phone
*
Fax Number
Salary/Wage
*
Were you subject to the FMCSR's while employed?
*
Yes
No
Reason for leaving
*
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?
*
Yes
No
Accident Record for the past 3 years
Attach sheet if more is needed
File
Accident Date
*
Nature of Accident
*
Roll over, Rear End, etc.
Fatalities
*
Yes
No
Injuries
*
Yes
No
If Yes, please explain
Accident Date
*
Nature of Accident
*
Roll over, Rear End, etc.
Fatalities
*
Yes
No
Injuries
*
Yes
No
If Yes, please explain
Accident Date
*
Nature of Accident
*
Roll over, Rear End, etc.
Fatalities
*
Yes
No
Injuries
*
Yes
No
If Yes, please explain
Accident Date
*
Nature of Accident
*
Roll over, Rear End, etc.
Fatalities
*
Yes
No
Injuries
*
Yes
No
If Yes, please explain
Driving Experience
Class and type of equipment
Straight Truck
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From / To Miles Driven
Tractor Semi Trailer
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From / To Miles Driven
Tractory 2 Trailer Combo
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From / To Miles Driven
Other
List all traffic fines & forfeitures for the past 3 years
Location
Date
Charge
Penalty
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
*
Yes
No
Has any license you've held ever been suspended or revoked?
*
Yes
No
If you answered "Yes" to any of the above please give details
Have you ever tested positive, or refused to test on any pre-employment drug test administered by an employer to which you applied for, but did not obtain, safety sensitive transportation work covered by DOT agency drug testing rules during the past 2 years?
*
Yes
No
If you answered "Yes" can you provide/obtain proof that you've successfully completed the DOT return-to-duty requirements?
Yes
No
Have you ever been convicted of a felony?
*
Yes
No
Untitled
*
I authorize you to make such investigations and inquiries of my personal, employment, financial medical history and other related matters as may be necessary in arriving 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 former employers, 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 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 of the company. 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. If you wish to review previous employer-provided investigative information, you must submit a written request to the Company, no later than 30 days after being employed or being notified of denial of employment. The Company will provide the requested investigative information to you within five (5) business days of receiving this written request, or five (5) business days of receipt of the requested information from the previous employer, whichever is later. This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.
I agree to the above
Signature
*
Signature Required (sign with mouse)
Photos
Locations
Childress
Shamrock
Jacksboro
Vernon
Memphis
Wichita Falls
Olney
Windthorst
Seymour