EMPLOYMENT APPLICATION YOUR NAME: ARE YOU OLDER THAN 18? Yes ADDRESS CITY ZIP CODE PHONE EMAIL DESIRED EMPLOYMENT: POSITION: SALARY DESIRED: DATE YOU CAN START: ARE YOU EMPLOYED NOW? YesNo IF YES, MAY WE INQUIRE EMPLOYER? YesNo EVER APPLIED OR WORKED FOR CALLEN TRUCKING: IF PREVIOUSLY EMPLOYED WITH CALLEN TRUCKING REASON FOR LEAVING: WHO REFERRED YOU TO CALLEN TRUCKING EMPLOYMENT AGENCYNEWSPAPER ADFRIENDSTATE EMPLOYMENT OFFICECOLLEGE PLACEMENT SERVICE 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 AClass B 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) 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) 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? YesNo IF YES, EXPLAIN: HAS ANY LICENSE, PERMIT, OR PRIVILEGE EVER BEEN SUSPENDED OR REVOKED? YesNo IF YES, EXPLAIN: EDUCATION: HIGH SCHOOL NAME + LOCATION WHAT YEAR DID YOU GRADUATE? YesNo COLLEGE NAME + LOCATION WHAT YEAR DID YOU GRADUATE? YesNo SPECIAL TRAINING OR SKILLS Trade, Business or Correspondence Schools FORMER EMPLOYERS: NAME OF PRESENT OR LAST EMPLOYER ADDRESS CITY STATE ZIP CODE START DATE LEAVING DATE WEEKLY STARTING SALARY WEEKLY ENDING SALARY POSITION DESCRIPTION OF WORK REASON FOR LEAVING MAY WE CONTACT YOUR SUPERVISOR? YESNO NAME OF SUPERVISOR SUPERVISOR CONTACT NAME OF NAME OF PREVIOUS EMPLOYER * OR LAST EMPLOYER ADDRESS CITY STATE ZIP CODE START DATE LEAVING DATE WEEKLY STARTING SALARY WEEKLY ENDING SALARY POSITION DESCRIPTION OF WORK REASON FOR LEAVING MAY WE CONTACT YOUR SUPERVISOR? YESNO NAME OF SUPERVISOR SUPERVISOR CONTACT REFERENCES 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? YesNo IF YES, EXPLAIN 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. Uploaded Your Signature
