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Driver (CDL Class A)
Driver (CDL Class A)
Application Form
First Name
*
Last Name
*
Phone Number
*
Email
*
Street Address
*
City
*
State
*
Zip Code
Are you 21 or older?
*
select an option
Yes
No
Driver’s License Number
*
Driver’s License State and Expiration
*
CDL License Class A or B
select an option
Class A
Class B
N/A
Were you previously employed by this Company?
select an option
Yes
No
List any relatives working for this Company
How were you referred to this Company?
Can you, after employment, submit a birth certificate or other proof of U.S. Citizenship?
*
select an option
Yes
No
If not a U.S. citizen, can you submit verification of your legal right to work in the U.S., after employment?
*
select an option
Yes
No
Have you ever been convicted of a misdemeanor or felony, pleaded no contest in a felony or fined over $500, during the last ten (10) years?
*
select an option
Yes
No
If Yes, please explain
Education / Military Service:
High School Name
HS Units Completed
College Name
College Units completed
Degrees / Diplomas
Honors / Awards
Other Accreditations
Dates of U.S. Military Service From / To
Branch of Service
Rank Held and Military Duties
Special Training
Employment History:
Present or Last Employer
*
Timing – From / To (Mo./Yr.)
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Address, City, State and Zip
*
Present or Last Employer Phone Number
Supervisor’s Name / Title
*
Position Held
*
Reason for Leaving
Description of Duties
If still employed, may we contact your employer?
select an option
Yes
No
Previous Employer #2
Timing – From / To (Mo./Yr.) #2
Address, City, State and Zip #2
Phone Number #2
Supervisor’s Name / Title #2
Position Held #2
Reason for Leaving #2
Description of Duties #2
Previous Employer #3
Timing – From / To (Mo./Yr.) #3
Address, City, State and Zip #3
Phone Number #3
Supervisor’s Name / Title #3
Position Held #3
Reason for Leaving #3
Description of Duties #3
Experience and Qualification:
Do you have forklift experience?
select an option
Yes
No
N/A
Do you have truck driving experience?
select an option
Yes
No
N/A
If Yes, which types?
List any other vehicles or equipment you are capable of operating
List any other special qualification that you feel would be assets to this Company
Accident History:
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
*
select an option
Yes
No
Has any license, permit or privilege ever been suspended or revoked?
*
select an option
Yes
No
If the answer to either of these questions is Yes, please provide detail
Describe any accidents involving a vehicle, driven by you, that have occurred in the last three (3) years, include date, place and nature or accident and end result
*
List any traffic convictions and forfeitures for the last three (3) years, not including parking violations
*
Applicant’s Certification
I certify that the information provided in this Application for Employment is true, correct and complete. I agree that if I am employed the Company may terminate my employment for any false or misleading statements or omissions in this Application, whenever they may be discovered. If the Company makes me a conditional offer of employment, I authorize a medical examination, including a drug and alcohol screening, by an examiner selected by the Company. I agree that if hired my employment is for no definite period and may be terminated at any time for any reason by either me or the Company. I agree that this cannot be changed except in writing by the Company’s President or General Manager and any representations to the contrary are not binding on the Company.
*
select an option
Agree
Do Not Agree
Authorization for Release of Information
I authorize the Chas. Seligman Dist. Co. to investigate my personal, financial and credit history through any investigative or credit agency or its choice. I authorize any references, school, former employer or other persons to disclose to Chas. Seligman Dist. Co. upon request, any information they may have about me and I release them from all liability for disclosing such information to the Company. I understand that the company may obtain or prepare an investigative consumer report in connection with my application for employment. I understand that I may make a written request for disclosure of the nature and scope of the investigation.
*
select an option
Agree
Do Not Agree
Cancel