CDL Application for Employment

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, handicap or national origin.

PERSONAL INFORMATION

Date______Social Security Number______

Name______

LastFirstMiddle

Present Address______

StreetCityStateZip

Prior Address______

(within the last 3 years)StreetCityStateZip

Phone Number______

Referred By______Are you 18 years of age or Older?______

EMPLOYMENT DESIRED

Position______Date You Can Start______Salary Desired______

Are you employed now? ______Is So May We Inquire of Your Present Employer? ______

Ever Applied to this Company Before? ______When? ______

DRIVER LICENSE

License Number______Expires______

State/Providence Issued:______Birthdate______

CDL ClassA______B______C______D______E______

DRIVING EXPERIENCE

Class of Equipment
/
Circle Type of Equipment
/ Dates /
Approx Miles (total)
Straight Truck / Van, Tank, Flat, Dump, Refer / From______
To______

Tractor and Semi-Trailer

/ Van, Tank, Flat, Dump, Refer / From______
To______

Tractor – Two Trailers

/ Van, Tank, Flat, Dump, Refer / From______
To______

Tractor- Three Trailers

/ Van, Tank, Flat, Dump, Refer / From______
To______

Van

/ __ / From______
To______

Flatbed

/ __ / From______
To______

Tanker

/ __ / From______
To______

Flatbed Rigging

/ __ / From______
To______

HazMat Hauling

/ __ / From______
To______

Heavy Equipment Hauling

/ __ / From______
To______

Motorcoach – School Bus(more than 8 passengers)

Motorcoach – School Bus(more than 15 passengers)

/ __ / From______
To______
From______
To______

Other:

/ From______
To______

Total MONTHS On-the-Road Experience______

List states operated in for last 5 years:______

SAFETY RECORD

Do you have a Hazardous Material Endorsement?Yes___No___

Do you have a Double/Triple Trailer Endorsement?Yes___No___

Do you have a Tanker Trailer Endorsement?Yes___No___

Do you have a Hazmat Tank Trailer Endorsement?Yes___No___

SAFETY RECORD (CONT’D)

Have you ever had your license revoked or suspended?Yes___No___

Have you had any accidents in the last 3 years?Yes___No___

Have you had any tickets in the last 3 years?Yes___No___

Have you been convicted of DWI, DUI or BAC in the last 7 Years?Yes___No___

Have you ever been convicted of a felony?Yes___No___

Have you ever been convicted of a crime?Yes___No___

If you answered Yes to any of the last six questions please give details below.

______

EXPERIENCE AND QUALIFICATIONS-OTHER

Show any Trucking, Transportation or other experience that may help in your work for Spirit Farms:

______

List courses and training other than shown elsewhere in this application:

______

List any special equipment or technical materials you can work with (other than those already shown):

______

FORMER EMPLOYERS

List below your previous employers over the last ten years, starting with the last one first

Date,Month,Year / Name and Address of Employer / Supervisor &
Contact Phone / Position / Ending Salary / Reason for Leaving
From______
To______
From______
To______
From______
To______
From______
To______
From______
To______
From______
To______
From______
To______
From______
To______
From______
To______
From______
To______

Were you subject to the FMCSRs while employed by any previous employer? Yes No

Was any of your previous employment designated as a safety sensitive function in any DOT regulated

mode subject to alcohol and controlled substances testing requirements of 49 CFR Part 40? Yes No

EDUCATION

School / Name and Location of School / Last Year Completed / Did You Graduate? / Subjects Studied & Degrees Received
Grammar School / ______
High School / ______
College / ______
Trade, Business or Correspondence School / ______

GENERAL

Subjects of Special Study or Research Work ______

______

Job Related Skills ______

______

Activities Other Than Religious (Civics, Athletic, etc.) ______

______

Exclude organizations, the name or character of which indicates the race, sex, color or national origin of its member.

REFERENCES

List below three persons not related to you, whom you have known at least one year.

Name / Address / Phone Number / Position / Years Acquainted
1.)
2.)
3.)

If you are to be hired by the company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.

AUTHORIZATION

I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company.

I understand that any employment is conditioned on a background check. I authorize the Company to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the Company, without giving me prior notice of such disclosure. In addition, I release the Company any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.

I authorize the company and/or its agents including consumer-reporting companies to verify any of this information. I authorize all persons, schools, companies, law enforcement agencies, and consumer reporting bureaus to release any and all information regarding my background. I release all parties from any liability for damage that may result from furnishing this information to you.

I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be “at will” and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the Company unless made in writing.

If I am offered employment I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by the Company and as Permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to the Company the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test, and if I am hired a condition of my employment will be that I abide by the Company’s Drug and Alcohol Policy.

By my signature on this application, I acknowledge that the company did not inquire about and I did not provide any information regarding conviction/arrest records that have been sealed or expunged.

I understand that filling out this form does not indicate there is a position open and does not obligate the Company to hire. If hired, I agree to abide by all Company work rules, policies and procedures. The Company retains the right to revise its policies or procedures, in whole or in part, at any time.

Date______Signature______

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