Name (First & Last):

Mailing Address:

Phone:

Email:

Present/Last Employer:

Phone:

Start Date:

End Date:

Ending Salary:

Reson for Leaving:

Accident Record for past 3 Years or more:

Last accident date:

Nature of accident:

Were there fatalities?

Were there any injuries:

Previous accident date:

Nature of accident:

Were there fatalities?

Were there any injuries:

Traffic Convictions & Forfeitures for past 3 Years (other than parking violations):

Ticket #1 - Location, Date, Charge, Penalty

Ticket #2 - Location, Date, Charge, Penalty

Ticket #3 - Location, Date, Charge, Penalty

Other Driving Information:

Have you ever been denied a driver's license, permit or privilege to operate a motor vehicle? Yes or No

Has any license, permit or privilege to operate a motor vehicle ever been suspended or revoked? Yes or No

If yes to either question, please explain below:

Type of Equipment Operated:

List all types of equipment you have operated:

Highest level of education completed:

Last school attended:

By submitting this application, I certify that I understand that nothing contained in this application or in the interview process is intended to create a contract, guarantee, promise, or covenant of any type between the Company and me. Should this application result in my employment, I or the Company have a right to terminate the employment relationship at any time and for any reason, without notice, cause, or any specific procedures. I further understand that no representative of the Company other than its Chief Executive Officer has any authority to enter into any agreement with me for any specified period of time or to guarantee some other personnel move or benefit. I further understand this entire statement applies to the period prior to or after I may be employed.

I authorize the work and any other individuals or entities listed in the application to give the Company or its designee any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties, including the Company, from all liability for any damages that may result from furnishing such information to the Company. 

I understand that any final offer of employment which might be made on behalf of the Company is conditioned, to the extent permitted by law, upon my satisfactorily passing a medical examination and drug/alcohol screening test, and upon any criminal conviction history, either prior to starting employment or any time during employment. I understand that a conviction record will not necessarily be a bar to employment with the Company. By my completion and execution of this application, I give my consent to any such test or examination and to the release of the results of any such test or examination to the appropriate designee(s) of the Company. 

This certifies that this application was completed by me, and that all entries on it and information on it are true and complete to the best of my knowledge. I understand that misrepresentations or omissions may be cause for rejection or subsequent dismissal if I am hired. 

I hereby acknowledge that I have read and understand each of the above statements.

By submitting this application, I give permission for the company to order MVR, DAC Reports, and do a Background Check.

Full Name of Applicant:

NOTE: By typing your name it will act as a digital signature and is legally binding.