Driver/CDL holder Job Application

Personal Information

Full Name (First + Middle + Last)*

Telephone Number*

Alternate Telephone Number

Present Address*

Street City State Zip Code

Addreses for past three years

Street	City	State	Zip Code

Position Applied For*

Salary Required:

Who referred you to seek employment here?

Are you legally eligible to work in the United States?*

Yes
No

Have you ever been convicted of a felony?*

Yes
No

In case of an emergency notify:

Name	Phone Number	Relationship	Address(Street/City/State/Zip)

Experience and Qualifications

List any special equipment you can operate

State qualifications which you feel may help you in the position for which you are applying: (i.e., experience, skills, etc)

State the nature and extent of any academic or professional education or vocational training you have had which is related to the position for which you are applying

Truck driving experience (years)

Types operated

Refuse collection experience (years)

Heavy equipment experience (type)

Maintenance shop experience (years)

Duties

List number and type of Safety Awards received

Motor Vehicle Operator Licenses you have held during the last 3 years*

State	License Number	Type	Expiration Date

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?*

Yes
No

Has any license, permit or privilege, ever been suspended or revoked?*

Yes
No

If the answer to either of the above questions is yes, please give details.

Accidents record for past 3 years

Accident	Dates	Nature of Accident	Fatalities	Injuries

Traffic convictions and bond or collateral forfeitures for the past 3 years

Location	Date	Charge	Penalty

Work Experience

Applicants to drive a commercial motor vehicle in intrastate or interstate commerce shall provide ten years information on those employers for whom the applicant has worked.

List below all present and past employment, beginning with your more recent.

1: Name of the Employer

1: Address of the Employer

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

1. Telephone

1: Dates Employed

From	To

1: Job Title

1: Description of duties

1: Supervisors Name & Position

1: Base Rate of Pay (Hour/Week/Month)

Start	End

1: Reason for Leaving?

1: May we contact this employer?

Yes
No

1: Would you like to list a another previous job?

Yes
No

2: Company Name

2: Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

2: Telephone

2: Dates Employed

From	To

2: Job Title

2: Description of duties

2: Supervisors Name & Position

2: Base Rate of Pay (Hour/Week/Month)

Start	End

2: Reason for Leaving?

2: May we contact this employer?

Yes
No

2: Would you like to list another previous job?

Yes
No

3: Company Name (Third Most Recent)

3: Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

3: Telephone

3: Dates Employed

From	To

3: Job Title

3: Description of duties

3: Supervisors Name & Title

3: Base Rate of Pay (Hour/Week/Month)

Start	End

3: Description of duties

3: Reason for Leaving?

3: May we contact this employer?

Yes
No

3: Would you like to list another previous job?

Yes
No

4: Company Name (Fourth Most Recent)

4: Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

4: Telephone

4: Dates Employed

From	To

4: Job Title

4: Description of duties

4: Supervisors Name & Title

4: Base Rate of Pay (Hour/Week/Month)

Start	End

4: Reason for Leaving?

4: May we contact this employer?

Yes
No

4: Would you like to list another previous job?

Yes
No

5: Company Name (FifthMost Recent)

5: Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

5: Telephone

5: Dates Employed

From	To

5: Job Title

5: Description of duties

5: Supervisors Name & Title

5: Base Rate of Pay (Hour/Week/Month)

Start	End

5: Reason for Leaving?

5: May we contact this employer?

Yes
No

5: Would you like to list another previous job?

Yes
No

6: Company Name (Sixth Most Recent)

6: Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

6: Telephone

6: Dates Employed

From	To

6: Job Title

6: Description of duties

6: Supervisors Name & Title

6: Base Rate of Pay (Hour/Week/Month)

Start	End

6: Reason for Leaving?

6: May we contact this employer?

Yes
No

6: Would you like to list another previous job?

Yes
No

7: Company Name (Seventh Most Recent)

7: Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

7: Telephone

7: Dates Employed

From	To

7: Job Title

7: Description of duties

7: Supervisors Name & Title

7: Base Rate of Pay (Hour/Week/Month)

Start	End

7: Reason for Leaving?

7: May we contact this employer?

Yes
No

7: Would you like to list another previous job?

Yes
No

8: Company Name (Eighth Most Recent)

8: Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

8: Telephone

8: Dates Employed

From	To

8: Job Title

8: Description of duties

8: Supervisors Name & Title

8: Base Rate of Pay (Hour/Week/Month)

Start	End

8: Reason for Leaving?

8: May we contact this employer?

Yes
No

8: Would you like to list another previous job?

Yes
No

9: Company Name (Ninth Most Recent)

9: Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

9: Telephone

9: Dates Employed

From	To

9: Job Title

9: Description of duties

9: Supervisors Name & Title

9: Base Rate of Pay (Hour/Week/Month)

Start	End

9: Reason for Leaving?

9: May we contact this employer?

Yes
No

9: Would you like to list another previous job?

Yes
No

10: Company Name (Tenth Most Recent)

10: Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

10: Telephone

10: Dates Employed

From	To

10: Job Title

10: Description of duties

10: Supervisors Name & Title

10: Base Rate of Pay (Hour/Week/Month)

Start	End

10: Reason for Leaving?

10: May we contact this employer?

Yes
No

In the event this application results in my employment by the Company, in consideration of my employment, I agree to abide by the Company’s rules, regulations, and policies, and my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of the Company. I further agree to submit, upon request, at any time, to a physical examination, including a test for drugs, controlled substances, or alcohol usage, by a Company physician. Except in connection with my job duties for the Company, I agree that, during the term of my employment with the Company and thereafter, I will neither reveal any confidential information or trade secrets to persons outside the Company nor use such confidential information or trade secrets on my behalf or that of any other. At no time will I interfere with the Company’s relationship with its other employees. My answers to the foregoing questions are given to induce the Company to employ me, and false statements will be considered sufficient cause for my dismissal in the event this application results in my employment. I give the Company the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Company and its representative for seeking such information and all other persons, corporations or organizations for furnishing such information. I understand that the information provided may be used and that my prior employers may be contacted for the purpose of investigating my background (as required by U.S. Departments of Transportation, Section 391.23). This certifies that the 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.

Digital Signature:*

Printing your First Name + Middle Initial + Last Name will act as your digital signature.

Date*

Informed Consent Form

Application Policies: 1. We do not always hire everyone who applies. 2. We may not interview you today. We may call you another day for an interview. 3. We do not always make hiring decisions instantly. Depending upon the number of applicants, decisions may take several days. 4. We do not discuss our hiring decisions with applicants. 5. We will call you if we have a job for you. 6. We are an Equal Opportunity Employer. I have read, understand, and agree to cooperate with these polices. I also understand that the information I provide about myself on application forms, on surveys, test, and during interviews will be used in making hiring decisions, and I consent to it being used for this process.

Digital Signature:*

Printing your First Name + Middle Initial + Last Name will act as your digital signature.

Date*

Personal Information

Experience and Qualifications

Work Experience

List below all present and past employment, beginning with your more recent.

Informed Consent Form

Alpine Waste & Recycling

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