EmailMe Form - EMPLOYMENT APPLICATION

Callen Trucking

YOUR NAME: *

ARE YOU OLDER THAN 18? *

Yes

ADDRESS *

CITY *

ZIP CODE *

PHONE *

EMAIL *

DESIRED EMPLOYMENT:

POSITION: *

SALARY DESIRED: *

DATE YOU CAN START: *

MM / DD / YYYY

ARE YOU EMPLOYED NOW? *

Yes

No

IF YES, MAY WE INQUIRE EMPLOYER?

Yes

No

EVER APPLIED OR WORKED FOR CALLEN TRUCKING*

IF YES, WHERE/WHEN/SUPERVISORS NAME

IF PREVIOUSLY EMPLOYED WITH CALLEN TRUCKING REASON FOR LEAVING: *

WHO REFERRED YOU TO CALLEN TRUCKING *

CDL

No person who operates a commercial motor vehicle shall at any time have more than one driver's license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years.

CLASS: *

Class A

Class B

STATE - LICENSE # - TYPE/CLASS *

ENDORSEMENTS + EXPIRATION DATE *

STATE - LICENSE # - TYPE/CLASS *

ENDORSEMENTS + EXPIRATION DATE *

PREVIOUSLY HELD LICENSES *

DRIVING EXPERIENCE: STRAIGHT TRUCK
DATE FROM - DATE TO:
APPROX. # OF MILES (TOTAL) *

DRIVING EXPERIENCE: TRACTOR & SEMI-TRAILER
DATE FROM - DATE TO:
APPROX. # OF MILES (TOTAL) *

DRIVING EXPERIENCE: TRACTOR & 2-TRAILERS
DATE FROM - DATE TO:
APPROX. # OF MILES (TOTAL) *

DRIVING EXPERIENCE: TRACTOR TANKER
DATE FROM - DATE TO:
APPROX. # OF MILES (TOTAL) *

DRIVING EXPERIENCE: OTHER
DATE FROM - DATE TO:
APPROX. # OF MILES (TOTAL) *

ACCIDENT RECORD IN THE PAST 3 YEARS:

DATES, NATURE OF ACCIDENT
(head-on, rear-end, upset, etc.)
#FATALITIES, #INJURIES, CHEMICAL SPILLS (Y/N) *

DATES, NATURE OF ACCIDENT
(head-on, rear-end, upset, etc.)
#FATALITIES, #INJURIES, CHEMICAL SPILLS (Y/N)

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS:

And other parking violations

DATE CONVICTED (mo./yr.),
VIOLATION + STATE OF VIOLATION
PENALTY: (Forfeited bond, collateral and/or points) *

DATE CONVICTED (mo./yr.),
VIOLATION + STATE OF VIOLATION
PENALTY: (Forfeited bond, collateral and/or points)

HAVE YOU EVER BEEN DENIED A LICENSE, PERMIT, OR PRIVILEGE TO OPERATE A MOTOR VEHICLE? *

Yes

No

IF YES, EXPLAIN:

HAS ANY LICENSE, PERMIT, OR PRIVILEGE EVER BEEN SUSPENDED OR REVOKED? *

Yes

No

IF YES, EXPLAIN:

EDUCATION:

HIGH SCHOOL NAME + LOCATION *

DID YOU GRADUATE? *

Yes

No

WHAT YEAR

COLLEGE NAME + LOCATION

DID YOU GRADUATE?

Yes

No

WHAT YEAR

SPECIAL TRAINING OR SKILLS
Trade, Business or Correspondence Schools

Year, Certificates and Subject Studied

FORMER EMPLOYERS:

NAME OF PRESENT OR LAST EMPLOYER *

ADDRESS *

CITY *

STATE *

ZIP CODE *

START DATE *

MM / DD / YYYY

LEAVING DATE *

MM / DD / YYYY

WEEKLY STARTING SALARY *

WEEKLY ENDING SALARY *

POSITION *

DESCRIPTION OF WORK *

REASON FOR LEAVING *

MAY WE CONTACT YOUR SUPERVISOR? *

YES

NO

NAME OF SUPERVISOR

SUPERVISOR CONTACT

NAME OF PREVIOUS EMPLOYER *

ADDRESS *

CITY *

STATE *

ZIP CODE *

START DATE *

MM / DD / YYYY

LEAVING DATE *

MM / DD / YYYY

WEEKLY STARTING SALARY *

WEEKLY ENDING SALARY *

POSITION *

DESCRIPTION OF WORK *

REASON FOR LEAVING *

MAY WE CONTACT YOUR SUPERVISOR? *

YES

NO

NAME OF SUPERVISOR

SUPERVISOR CONTACT

REFERENCES

NAME *

ADDRESS *

BUSINESS

YEARS ACQUAINTED

NAME *

ADDRESS *

BUSINESS

YEARS ACQUAINTED

NAME *

ADDRESS *

BUSINESS

YEARS ACQUAINTED

SERVICE RECORD

BRANCH OF SERVICE + DISCHARGE DATE / RANK

FELONY RECORD

HAVE YOU BEEN CONVICTED OF A FELONY WITHIN THE LAST 5 YEARS? *

YES

NO

IF YES, EXPLAIN

(WILL NOT NECESSARILY EXCLUDE YOU FROM CONSIDERATION)

AUTHORIZATION

BY SUBMITTING THIS APPLICATION
'I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETED TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES AND EMPLOYERS 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 THE COMPANY FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM UTILIZATION OF SUCH INFORMATION.

I ALSO UNDERSTAND AND AGREE THAT NO REPRESENTATIVE OF THE COMPANY HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING, UNLESS IT IS IN WRITING AND SIGNED BY ANY AUTHORIZED COMPANY REPRESENTATIVE.

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