Large Truck Job Application - Bonded Transportation Solutions

APPLICATION FOR EMPLOYMENT

Date / Time

Date

Time

Name *

First

Last

Phone

Email *

Social Security Number

Date of Birth

How were you referred to Bonded Transportation Solutions?

Address

Address Line 1

Address Line 2

City

State

Zip Code

I am applying for (check one)

Full Time
Part Time

Hours Available

I am interested in driving

Company vehicle
My own vehicle

Type of Vehicle Owned (Year, Make, Model, Color)

Vehicle Insurance Company

Agent Name

First

Last

Agent Phone Number

Policy Number

Person to notify in emergency

First

Last

Emergency contact phone number

AFTER READING AND STUDYING THE JOB DESCRIPTION FOR THE POSITION YOU ARE APPLYING FOR, IS THERE ANYTHING THAT WOULD ADVERSELY AFFECT YOUR ABILITY TO PERFORM THE DUTIES AND RESPONSIBILITIES OF THIS JOB? (If so, please explain.)

Have you worked for this company before?

Yes
No

If yes, list dates of employment

Are you currently employed?

Yes
No

If not, how long since leaving last employer?

EDUCATION

High School Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Last Grade Completed

EMPLOYMENT HISTORY

Please list all employers for the past 5 years

Company name (Most recent employer)

Supervisor

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Reason for leaving

From Date

To Date

May we contact them?

Yes
No

Salary

Company name (Second most recent employer)

Supervisor

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Reason for leaving

From Date

To Date

May we contact them?

Yes
No

Salary

EXPERIENCE & QUALIFICATIONS FOR DRIVING POSITION

Enter in your experience and qualifications information

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

Yes
No

Has any license or permit ever been suspended or revoked?

Yes
No

If yes, give dates and reason for denial, revocation or suspension

DRIVING EXPERIENCE

Enter driving experience information

Van driving experience

Straight Truck driving experience

Tractor/Trailer driving experience

List states operated in during last five years:

Have you ever received any “Safe Driving” awards?

Yes
No

If yes, please provide details

Do you have any trucking/transportation or other experience that may be helpful to Bonded Transportation Solutions, Inc.?

Do you have any special courses or training that will help you as a driver? If so, please explain.

Accident Review for Past 5 Years

Date / Time

Nature of Accident (Head-on, Rear End, etc)

Chargeable?

Yes
No

Injuries?

Yes
No

Fatalities?

Yes
No

Traffic Convictions/Forfeitures for Past 5 Years

(Do not include parking violations)

Date / Time

Charge

Penalty

Location

CRIMINAL RECORD

Have you ever been convicted of a crime?

Yes
No

If so, please describe each criminal conviction, the circumstances of each conviction in the space provided below.

Do you have any current pending criminal charges against you?

Yes
No

If so, please describe the circumstances of the current pending charges below. Do not include any arrests which have been dismissed, resolved or which otherwise are no longer currently pending. (THE FACT THAT YOU MAY HAVE CRIMINAL CONVICTION(S) OR CURRENT CHARGE(S) DOES NOT AUTOMATICALLY DISQUALIFY YOU FROM CONSIDERATION FOR EMPLOYMENT.)

TO BE READ AND SIGNED BY APPLICANT

This certifies that this application was completed by me, and that all entries on and information in it are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my person, employment, financial, and/or medical history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers from all liability in responding to inquiries in connection with my application. In the event of employment, I understand that false or misleading information given on my application or during an interview may result in discharge. I understand also, that I am required to abide by all rules and regulations of the Company as permitted by Law.

I agree to the term above *

Yes

Name *

First

Last

Date *