Printable Application for
EmploymentPrintable Application for
Employment
| NAME | ||
_______________________ |
____________________ | _________________ |
| Last | First | Middle |
| ____________________ | ||
| Social Security Number | ||
| ADDRESS | ||
___________________________________________________________________ |
||
| Street | ||
| _______________________ | ____________________ | _________________ |
| City | State | Zip Code |
| PERSONAL | ||
_______________________ |
_______________________ | |
| Telephone Number | ||
| Date of Birth____/____/____ | Availability Date____/____/____ | |
| DRIVERS LICENSE INFORMATION | ||
______________________ |
__________ | ____/____/____ |
| Number | State | Expires on |
| DRIVER RECORD | ||
| Do you have a CDL? | Yes No | |
| Do you have a Haz-Mat Endorsement? | Yes No | |
| Have you ever received tickets in the last 3 years? | Yes No | |
| If yes, how many tickets? | _____ | |
| When and what were the tickets | ||
| ________________________________________________________________ | ||
| ________________________________________________________________ | ||
| ________________________________________________________________ | ||
| ________________________________________________________________ | ||
| Number of accidents in the last three years: | _____ | |
| Amount of damage in dollars: | $ ____________ | |
| How many were your fault | _____ | |
| Have you ever been arrested for driving while intoxicated? | Yes No | |
| If yes, when? ________________________ | ||
| How many times? | _____ | |
| Has your license ever been suspended or revoked? | Yes No | |
| If yes, when? ________________________ | ||
| Have you ever been convicted or charged with a crime? | Yes No | |
| If yes, when? ________________________ | ||
| What were you convicted or charged with: | ||
________________________________________________________________ |
||
________________________________________________________________ |
||
________________________________________________________________ |
||
________________________________________________________________ |
||
| List your last three years of employment if you are inexperienced and ten years if you are an experienced driver | ||
| 1. EMPLOYER | ||
| Employed: From: ____________ To: ____________ | ||
| Employer Name: ____________________________________________________ | ||
| Address: __________________________________________________________ | ||
| City________________________ State ____________ | Zip ____________ | |
| Telephone (_______) - _______ - ____________ | ||
| Type of Trailer: ____________________________________ | ||
| Job Title: ____________________________________ | ||
| Number of States: ____________ | ||
| Reason for leaving: | ||
________________________________________________________________ |
||
| ________________________________________________________________ | ||
| ________________________________________________________________ | ||
| ________________________________________________________________ | ||
| 2. EMPLOYER | ||
| Employed: From: ____________ To: ____________ | ||
| Employer Name: ____________________________________________________ | ||
| Address: __________________________________________________________ | ||
| City________________________ State ____________ | Zip ____________ | |
| Telephone (_______) - _______ - ____________ | ||
| Type of Trailer: ____________________________________ | ||
| Job Title: ____________________________________ | ||
| Number of States: ____________ | ||
| Reason for leaving: | ||
________________________________________________________________ |
||
| ________________________________________________________________ | ||
| ________________________________________________________________ | ||
| ________________________________________________________________ | ||
| 3. EMPLOYER | ||
| Employed: From: ____________ To: ____________ | ||
| Employer Name: ____________________________________________________ | ||
| Address: __________________________________________________________ | ||
| City________________________ State ____________ | Zip ____________ | |
| Telephone (_______) - _______ - ____________ | ||
| Type of Trailer: ____________________________________ | ||
| Job Title: ____________________________________ | ||
| Number of States: ____________ | ||
| Reason for leaving: | ||
________________________________________________________________ |
||
| ________________________________________________________________ | ||
| ________________________________________________________________ | ||
| ________________________________________________________________ | ||
| PERSONAL REFERENCE | ||
Name: ____________________________________________________________ |
||
| Relationship: ____________________ Telephone Number: ___________________ | ||
| By
submitting this application, I hereby certify that all information on this form is correct
and complete to the best of my knowledge. I hereby authorize Sanders, Inc, to obtain
information concerning my past or current work history, and to do a complete background
investigation in accordance with state and federal laws. I hereby release all such persons
from any liability or damages.
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