Driver Application - Bates Trucking & Trash Removal, Inc

Applicant Information

Name *

First

Last Name *

Last

MI

Birth Date *

Social Security No.

Email *

Street Address *

City *

State *

Zip *

Home/Cell Phone *

Business Phone

How Did You Hear About Us? * How Did You Hear About Us?

Have you ever been in the armed forces? *

Yes

No

Are you now a member of the National Guard? *

Yes

No

Have you ever applied for employment with us? *

Yes

No

Have you operated heavy motor vehicles for at least 3 years? *

Yes

No

Do you have at least 3 years experience with air brakes? *

Yes

No

Do you have a current/valid CDL license? *

Yes

No

MM/YY *

Location *

Were you previously employed by this organization? *

Yes

No

Were you previously employed by this organization? *

Yes

No

MM/YY *

Department/Position *

Are you able to get to work by 5:00am, or earlier if needed? *

Yes

No

Position Desired *

Pay Expected *

Date Available to Begin Work *

Apart from absence for religious observance, are you available for full-time work? *

Yes

No

Will you work overtime if asked? *

Yes

No

Are you legally eligible for employment in the United States? *

Yes

No

Other special training or skills (languages, machine operation, etc.)

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Education

High School

Name and Location of School *

Course of Study *

Years Completed *

Degree or Diploma

Did you Graduate? *

Yes

No

College

Name and Location of School

Course of Study

Years Completed

Degree or Diploma

Did you Graduate?

Yes

No

Business/Trade/Graduate/Technical

Name and Location of School

Course of Study

Years Completed

Degree or Diploma

Did you Graduate?

Yes

No

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Employment

Please give accurate, complete full-time and part-time employment record. Start with your present or most recent employer. Background checks are performed on all applicants. Please provide the telephone number and the address for your previous employers. Our inability to verify the past employment information may hinder or delay processing of your application. Use an additional sheet of paper if necessary.

Company Name *

Phone

Address *

Name of Supervisor *

Employed From *

Start MM/YY

Employed To MM/YY

End MM/YY

Weekly Pay *

Start

Last Weekly Pay

Last

State Job Title and Describe Your Work *

Reason for Leaving

May we contact this Employer? *

Yes

No

Enter another employer? *

Yes

No

Company Name *

Phone

Address *

Name of Supervisor *

Employed From *

Start MM/YY

Employed To MM/YY

End MM/YY

Weekly Pay *

Start

Last Weekly Pay

Last

State Job Title and Describe Your Work *

Reason for Leaving

Enter another employer? *

Yes

No

Company Name *

Phone

Address *

Name of Supervisor *

Employed From *

Start MM/YY

Employed To MM/YY

End MM/YY

Weekly Pay *

Start

Last Weekly Pay

Last

State Job Title and Describe Your Work *

Reason for Leaving *

We may contact the employers listed above unless you indicate those you do not want us to contact.

Employers you DO NOT want us to contact

Reason

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Other Information

The information requested is needed for a legally permissible reason, including, without limitation, national security considerations, a legitimate occupational qualification or business necessity. The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex or national origin. Federal law also prohibits discrimination based on age, citizenship and disability. The laws of most States also prohibit some or all of the above types of discrimination as well as some additional types such as discrimination based upon ancestry, marital status and sexual preference.

What was your previous address?

Have you had any moving violations in the last 3 years? *

Yes

No

Please explain. Provide dates and violations. *

Have you been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by a court? *

Yes

No

If "Yes", please descibe in full. *

State names of relatives and friends working for us, other than your spouse.

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Record & License Information

List all traffic violations for which you have been convicted or forfeited donor collateral in the past three years. If none, write none. *

List all valid driver’s licenses that you currently hold. Include multiple licenses, if you have them. *

Have you ever had a restriction/suspended license? *

Yes

No

Have you ever been convicted for driving under the influence of alcohol or drugs? *

Yes

No

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

Yes

No

Are your driving privileges currently under probation, suspension or restrictions? *

Yes

No

Have you ever pled guilty to a crime or been convicted of a felony? *

Yes

No

If Yes to any of the above, please explain. *

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Disclaimer and Confirmation

Checkboxes *

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

Checkboxes *

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

End Section