Address For Past Three Years

Do you have the legal right to work in the United States yesno
Are you over the age of 18
If no can you provide proof of age yesno
Have you worked for this company before yesno
Are you now employed

Is there any reason you might be unable to perform the functions of the job for which you have applied
(as described in the attached job description)yesno

Employment History

Employer One

Employer Two

Employer Three

Employer Four

Military Status

Have You Served in the U.S Military


Highest Grade Completed

Experience and Qualifications - Platform

Experience and Qualifications - Maintenance

Hydraulic Air Brakes yes
Sheet Metal Equipment yes
Clutch Rebuild yes
Transmission Rebuilding yes
Body Work yes
Frame & Axle Straightening Equipment yes
Electrical & Ignition Troubleshooting/Repair yes
Engine Rebuilding yes
Diesel Injection Equipment yes
Electric Welder yes
Oxyacetylene Welder yes
Chassis Dynamometer yes
Inspection License yes
Computer Knowledge yes
Other yes
Forklift Certification yes
Parts/Warehouse Distribution yes
Tire Repair yes
Engine Dynamometer yes
List Courses and Training in Maintenance Work

Experience and Qualifications - Clerical

Payroll Processing yes
Account Receivables yes
Account Payables yes
Dispatching yes
Dispatching Software yes
GPS Software yes
Truck Weight/Trip Permitting yes
Driver Payroll Calculationyes
Routing Software yes
Training Other Staff yes
Computer Skillsyes
Receptionist/Greeter yes
Billing yes
Customer Service yes
List Courses and Training in Maintenance Work

Experience and Qualifications - Other

To be read and signed by applicant

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

As part of the application process, I am aware that certain prequalification procedures are involved. This may include a driving test, classroom attendance and other pre hiring examinations. I understand and agree that during this period I am not an employee of the company, and I am not entitled to receive any pay or compensation for my time spent in these procedures. No such testing by the Company shall be deemed to be a hiring until such time as I receive written notification from a Company official.

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.