Application for Semi Delivery Driver - Class A CDL Required - Employment

Basic Information

First Name*

Last Name*

Middle Name*

Present Address*

City*

State*

Zipcode*

Phone Number*

Permanent Phone Number*

Email Address*

19 years or older?*

Yes No

Education

Are you currently a student?*

Yes No

Where?

Major/Area of Study?

Expected Graduation Date?

Are you a college graduate?*

Yes No

Where?

Are you a high school graduate?*

Yes No

Where?

Driving Information

Do you have a valid driver's license?*

Yes No

Driver’s License (State)

License Number

Expiration Date

Have you been convicted of a DUI within the last five years?*

Yes No

Background Information

Have you been convicted of a felony within the last 7 years?*

Yes No

If yes, explain below (conviction will not necessarily disqualify applicant from employment)

Special Skills

Do you have any special skills which you would like to tell us about?

Addresses for the Past Three Years

Street

City

State

Zipcode

From

Street

City

State

Zipcode

From

Add another

Experience and Qualifications
Traffic convictions and forfeitures for the past three years (other than parking violiations)

Location

Date

Charge

Penalty

Add another

Equipment Experience

Class

Type of Equipment

Dates

Approximate Number of Miles

Add another

Accident Record for the Past Three Years (or More)

Date

Nature of Accident

Fatality / Injury / Non-Injury

Add another

Employment History

Name & Location of Employer

Address

From

Supervisor

Your positions / responsibilities

Reason for Leaving

Add another

Personal References

Name

Relation

Phone Number

Add another

Schedule

How many hours per week would you like to work?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

*if hired, your schedule may or may not use all your available hours.

Additional information about your schedule or events coming up?

Other Questions

How does a short term temp position such as this fit into your plans?

Release and Confirmation

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be grounds for immediate dismissal.

I authorize investigation of all statements contained herein and the referrals listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand and agree that, if hired, any employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice.

I understand that entering my full legal name in the box below is the electronic equivalent of a signature.

Enter your full legal name in the box below if you agree to the Release and Confirmation.*

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