Personal Information |
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| First Name : |
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| Last Name : |
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| Address 1 : |
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| Address 2 : |
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| City / State / Zip Code |
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| Email address : |
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| Social Security Number : |
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| Phone Number : |
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| Alternate Phone Number : |
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| Best time to call : |
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Desired Position |
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| Position : |
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| Desired Wage : |
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License Information
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| Do you have a Commercial Driver's License? |
Yes
No |
| If yes, which class? |
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| If no, would you be willing
to get your CDL? |
Yes
No |
| Do we have your authorization to run your MVR? |
Yes
No |
| License Number : |
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| State : |
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| Date of Birth : |
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Employment History |
| Current Employer : |
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| Dates Employed : |
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| Address 1 : |
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| Address 2 : |
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| City / State /Zip: |
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| Contact : |
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| Phone : |
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| Job Description : |
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| Reason for leaving : |
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| Starting wage : |
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| Ending Wage : |
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| May we contact your current employer? |
Yes
No |
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| Previous Employer 1 : |
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| Dates Employed : |
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| Address 1 : |
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| Address 2 : |
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| City / State / Zip : |
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| Contact : |
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| Phone : |
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| Job Description : |
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| Reason for leaving : |
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| Starting wage : |
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| Ending Wage : |
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| Previous Employer 2 : |
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| Dates Employed : |
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| Address 1 : |
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| Address 2 : |
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| City / State / Zip : |
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| Contact : |
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| Phone : |
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| Job Description : |
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| Reason for leaving : |
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| Starting wage : |
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| Ending Wage : |
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Experience |
How much experience do you have (number of years)? If none enter "0" |
| Class A: |
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| Class B with air brakes: |
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| With Flatbed : |
(OH, IN, NC, GA) |
| Mountain Driving : |
(CO or AZ) |
| Multiple-Stop Delivery : |
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Violations |
| Moving violations in the last 3 years, in any state (personal or commercial vehicle) |
| 1) Year/State/Type/Vehicle Type |
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| 2) Year/State/Type/Vehicle Type |
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| 3) Year/State/Type/Vehicle Type |
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| Accidents in the last 3 years, in any state (personal or commercial vehicle) |
| 1) Year/State/Type/Vehicle Type |
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| 2) Year/State/Type/Vehicle Type |
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| Have your license EVER been suspended or revoked? |
Yes
No |
| If yes, when and why? |
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| Have you ever been convicted of the following DUI/DWI? |
Yes
No |
| If yes, when? |
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| Have you ever been sited for Careless or Reckless Operation? |
Yes
No |
| If yes, when? |
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| Have you ever pled "guilty" or "no contest" to, or been convicted of a crime? |
Yes
No |
| if Yes, please explain |
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| Convicted of a Misdemeanor or Felony? |
Yes
No |
| If yes, when and why? |
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| Do you have any charges pending? |
Yes
No |
| If yes, explain |
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| Can you legally go into Canada? |
Yes
No |
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Skills and Qualifications |
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Please summarize any special training,
skills, computer software, licenses and/or
certifications you have that may assist
you in performing the position you are
applying for. |
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Education |
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| School Name : |
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| School City / State : |
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| Number of Years Completed : |
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| Received : |
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| Major/Minor : |
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By signing your Initials below you accept the information in this application for employment to be true. Falsification of any information contained in the application will void this application for employment.
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Mechanic Application 
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