Job Application

Your Information

First Name

Middle Name

Last Name

Date of Birth

Phone

Alternate Phone

Position You Are Applying For

Where did you hear about this position?

Are you legally eligible to work in the United States? Yes No

Are you over 18 years of age? Yes No

Have you ever been employed with us before? Yes No

Are you related to anyone employed by us? Yes No

Your Residency (past 3 years)

Address

City

State

Zip

Number of Years

Are you currently employed? Yes No

Can we contact your current employer? Yes No

Do you have any commitments that might affect your employment with your company? Yes No

Please explain:

Are you able to perform the job duties described without accommodation? Yes No

What accommodations are necessary to enable you to perform the described job duties?

Date available to start work

What days and hours are you available to work?

Your Education

Do you have a high school diploma or GED? Yes No

High School/GED City

Additional Schools Beyond High School

School/City/State

Course of Study

Did you graduate? Yes No

Please describe any specialized training, apprenticeships, licenses or certificates:

Your Work History

All applicants wishing to drive in interstate commerce must provide the following information on all employers during the preceding three (3) years. You must give the same information for all employers for whom you have driven a commercial vehicle seven (7) years prior to the initial three years (total of ten year employment record).

Employer

Address/City/State/Zip

Supervisor Name

Supervisor Phone

Reason for leaving

Start Date

End Date

Position(s) held and major job duties

*Account for Period Between Jobs

Were you subject to the FMCSRs** while employed? Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? Yes No

*Any gaps in employment and/or unemployment must be explained.
*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.
**The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weights or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

Driving Experience (past 3 years)

Check here if you have no driving experience in the past 3 years

Class of Equipment	Type of Equipment	Dates		Approximate Number of Miles
Class of Equipment	Type of Equipment	From	To	Approximate Number of Miles
Straight Truck	Van Reefer Tank Flat
Tractor & Semi-Trailer	Van Reefer Tank Flat
Tractor - Two Trailers	Van Reefer Tank Flat
Tractor - Three Trailers	Van Reefer Tank Flat
Motorcoach - School Bus (Greater than 8 passengers)	N/A
Motorcoach - School Bus (Greater than 15 passengers)	N/A
Other:	Van Reefer Tank Flat

Accident History (past 3 years)

Check here if you have have had no accidents in the past 3 years

Month

Year

Nature of Accident

No. of Fatalities

No. of Injuries

Hazardous Materials Spill Yes No

Traffic Convictions and Forfeitures (past 3 years)

Check here if you have had no traffic convictions or forfeitures in the past 3 years

Month

Year

Violation

State of Violation

Penalty

License/Permit Information

Please provide your driver licenses or permits held in the past 3 years.

Licensing Authority

License Number

Class

Endorsement(s)

Expiration Date

Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Yes No

Please explain:

Has any license, permit, or privilege ever been suspended or revoked? Yes No

Please explain:

Resume and Cover Letter (Optional)

Resume

Cover Letter

Please include additional information that could help you qualify for this position:

Agreement

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

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU.

I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OR PAYMENT OF WAGES OR SALARY BE TERMINATED BY ME OR T&R RECYCLING, LLC. AT ANY TIME WITHOUT PRIOR NOTICE.

My typed first and last names below shall have the same force and effect as my written signature.

Signature

Date

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