EMPLOYMENT APPLICATION

Date

YYYY

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Phone

(###)

###

####

Date Available

YYYY

Desired Salary

Position Applied for:

Are you a citizen of the United States

If no, are you authorized to work in the U.S.?

Have you ever worked for this company?

If yes, when?

Do you have a reference from someone who works here? If so, who?

Have you ever been convicted of a felony?

Do you currently have a valid drivers license?

If you have a felony and/or no drivers license, please explain.

High School attended

High School Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

From When to When?

Did you graduate?

Diploma

PREVIOUS EMPLOYMENT

Give a COMPLETE RECORD of 3 most recent employers. ALL fields MUST be filled in completely.

EMPLOYER 1

Employer Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Contact Name

Beginning Date

YYYY

End Date

YYYY

Position Held

Salary / Wage

Reason for Leaving

EMPLOYER 2

Employer Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Contact Name

First Name

Last Name

Beginning Date

YYYY

End Date

YYYY

Position Held

Salary / Wage

Reason for Leaving

EMPLOYER 3

Employer Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Contact Name

First Name

Last Name

Beginning Date

YYYY

End Date

YYYY

Position Held

Salary / Wage

REFERENCES

Please list three professional references

REFERENCE 1

Full Name

Relationship

Company

Phone

(###)

###

####

REFERENCE 2

Full Name

Relationship

Company

Phone

(###)

###

####

REFERENCE 3

Name

First Name

Last Name

Relationship

Company

Phone

(###)

###

####

Driving Experience

Please check all that apply.

Straight Truck

Tractor and Semi-Trailer

Tractor-two trailers

Motor Coach - School Bus

None

List Dates & Miles of Driving Experience

Please list out the dates of your driving experience with the approximate number of miles.

List States Operated in the Past 5 Years

List Any Special Courses / Training Completed (PD/DDC/Haz Mat., Etc.)

List Any Safe Driving Awards you hold and from whom

Accident Record for the past 3 years, write "NONE' if applicable

Please list out: Date of Accident / Nature of Accident / Location of Accident / Number of Fatalities / Number of Injuries

Traffic Convictions for the past 3 years, write "NONE" if applicable (attach sheet if additional space is needed)

Please write out: Date / Location / Charge / Penalty

Driver's License (List each driver's license held in the past 3 years)

State / License # / Type / Endorsements / Expiration Date

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

Has any license, permit or privelege been suspended or revoked?

Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)?

If you answered yes to any of these questions, give details

Disclaimer

It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty. It is agreed and understood that the motor carrier or his agents may investigate the applicant’s background to ascertain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his furnishing such information. It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigating Consumer Report, including information regarding my character general reputation, personal characteristics and mode of living. I agree to furnish such additional information and complete such examinations as may be required to complete my application file. It is agreed and understood that this Application in no way obligates the motor carrier to employ or hire the applicant. It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified without recourse. 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.

Signature

First Name

Last Name

EMPLOYMENT APPLICATION

3696 1st avenue
greeley, CO 80631

970.673.4800
contact@elevateenergysvs.com