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Personnal Information |
| Position Applied For: |
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| Name: last,
first initial |
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| Phone |
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| Social Security Number: |
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Current Address:
Address
Suite or Apt
City State Zip
|
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|
List your addresses
of residency for the past 3 years |
Previous
Addresses :
Address
Suite or Apt
City State Zip
|
|
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Address
Suite or Apt
City State Zip |
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|
Address
Suite or Apt
City State Zip |
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| Do You have the legal
right to work in the United States: |
Yes |
| Date of Birth: |
MM/DD/YY |
| Can You provide Proof
of Age?: |
Yes |
| Have You worked for Joule
Yacht Before?: |
Yes |
| |
If "Yes" |
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Where: |
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Dates: |
From:
MM/DD/YY
__To :
MM/DD/YY |
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Rate of Pay: |
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Position: |
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| Have You Ever Been Bonded: |
Yes |
| |
If "Yes" |
|
Name of Bonding Company: |
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| |
| Have You Ever Been Convicted
of a Felony: |
Yes |
| |
If "Yes" |
|
Please Explain:
Conviction of a crime is not
an automatic bar to employment. |
|
| |
| Is there any reason you
might be unable to perform the functions of the job for
which you have applied: |
Yes |
| |
If "Yes" |
|
Please Explain: |
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|
Employment History
|
All driver applicants
to drive in interstate commerce must provide the following
information on all employers during the preceding 3 years.
List complete mailing addres, stret number, city, state
and zip code.
Applicants to drive a commercial motor vehicle in intrastate
or interstate commerce shall also provide an additional
7 years information on those employers for whom the applicant
operated such vehicle.
NOTE: List employers in reverse order starting with the
most recent.
* Inlcudes vehicles having a GVWR of 26,001 lbs. or more,
vehciles designated 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 operationg amotor vehicle on a highway
in interstate commerce to transport passengers or property
when the vehicle (1) weighs or has a GVWR of 10,001 punds
or more, (2) is designed or used to transport more than
8 passengers(including the driver), OR (3) is of any size
and is used to transport hazardous materials in a quantity
requiring placarding. |
| Employer Name: |
|
|
Employer Address:
Address
Suite or Apt
City State Zip |
|
| Employer Contact Person: |
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| Employer Phone Number: |
|
| Dates: |
From:
MM/DD/YY
__To:
MM/DD/YY |
| Salary / Wage: |
|
| Reason for Leaving: |
|
| Were you subjected to
the FMCSRs while employed?: |
Yes |
| Was your job designated
as a safety sensitive function on any DOT regulated mode
subject to the drug and alcohol testing requirements of
49 CFR Part 40?: |
Yes |
| |
| Employer Name: |
|
|
Employer Address:
Address
Suite or Apt
City State Zip |
|
| Employer Contact Person: |
|
| Employer Phone Number: |
|
| Dates: |
From:
MM/DD/YY
__To:
MM/DD/YY |
| Salary / Wage: |
|
| Reason for Leaving: |
|
| Were you subjected to
the FMCSRs while employed?: |
Yes |
| Was your job designated
as a safety sensitive function on any DOT regulated mode
subject to the drug and alcohol testing requirements of
49 CFR Part 40?: |
Yes |
| |
| Employer Name: |
|
| Employer Address: |
|
| Employer Contact Person: |
|
| Employer Phone Number: |
|
| Dates: |
From:
MM/DD/YY
__To:
MM/DD/YY |
| Salary / Wage: |
|
| Reason for Leaving: |
|
| Were you subjected to
the FMCSRs while employed?: |
Yes |
| Was your job designated
as a safety sensitive function on any DOT regulated mode
subject to the drug and alcohol testing requirements of
49 CFR Part 40?: |
Yes |
| |
| Employer Name: |
|
| Employer Address: |
|
| Employer Contact Person: |
|
| Employer Phone Number: |
|
| Dates: |
From:
MM/DD/YY
__To:
MM/DD/YY |
| Salary / Wage: |
|
| Reason for Leaving: |
|
| Were you subjected to
the FMCSRs while employed?: |
Yes |
| Was your job designated
as a safety sensitive function on any DOT regulated mode
subject to the drug and alcohol testing requirements of
49 CFR Part 40?: |
Yes |
| |
| Employer Name: |
|
| Employer Address: |
|
| Employer Contact Person: |
|
| Employer Phone Number: |
|
| Dates: |
From:
MM/DD/YY
__To:
MM/DD/YY |
| Salary / Wage: |
|
| Reason for Leaving: |
|
| Were you subjected to
the FMCSRs while employed?: |
Yes |
| Was your job designated
as a safety sensitive function on any DOT regulated mode
subject to the drug and alcohol testing requirements of
49 CFR Part 40?: |
Yes |
| |
|
|
Driving Record |
|
Accident record
for the past 3 years or more: |
| Last Accident: |
|
|
Date |
|
|
Nature of Accident:
(head-on, rear-end, upset, etc) |
|
|
Fatalities |
|
|
Injuries |
|
|
HAzardous Materials
Spill |
|
| |
| Next Previous Accident: |
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|
Date |
|
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Nature of Accident:
(head-on, rear-end, upset, etc) |
|
|
Fatalities |
|
|
Injuries |
|
|
HAzardous Materials
Spill |
|
| |
|
Date |
|
|
Nature of Accident:
(head-on, rear-end, upset, etc) |
|
|
Fatalities |
|
|
Injuries |
|
|
HAzardous Materials
Spill |
|
| |
| Traffic Convictions and
Forfeitures for the past 3 years ( other than parking
violations). |
None |
| |
If "Yes" |
|
Location: |
|
|
Date: |
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|
Charge: |
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Penalty: |
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| |
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Location: |
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Date: |
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|
Charge: |
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Penalty: |
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| |
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|
Location: |
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|
Date: |
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|
Charge: |
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Penalty: |
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| |
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Location: |
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Date: |
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Charge: |
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Penalty: |
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| |
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|
Driving Experience
& Qualifications |
|
Drivers Licenses |
|
State: |
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License Number: |
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Type: |
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Expiration Date: |
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State: |
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License Number: |
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Type: |
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|
Expiration Date: |
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State: |
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License Number: |
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Type: |
|
|
Expiration Date: |
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State: |
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License Number: |
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Type: |
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|
Expiration Date: |
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| Have you have ever been
denied a license, permit or privledge to operate a motor
vehicle? |
Yes |
| Has any license permit
or privledge ever been suspended or revoked? |
Yes |
| |
If "Yes"
to either question. Please Explain |
| |
|
| |
| Driving Experience: |
check yes
to those that apply |
|
Straight Truck: |
Yes |
|
Type Of Equipment: |
Van |
Tank |
Flat |
Dump |
Refer |
|
Dates: |
From:
MM/DD/YY
__To:
MM/DD/YY |
|
Aprox. Number Of
Miles: |
|
| |
|
Tractor and Semi-Trailer: |
Yes |
|
Type Of Equipment: |
Van |
Tank |
Flat |
Dump |
Refer |
|
Dates: |
From:
MM/DD/YY
__To:
MM/DD/YY |
|
Aprox. Number Of
Miles: |
|
| |
|
Tractor - Two Trailers: |
Yes |
|
Type Of Equipment: |
Van |
Tank |
Flat |
Dump |
Refer |
|
Dates: |
From:
MM/DD/YY
__To:
MM/DD/YY |
|
Aprox. Number Of
Miles: |
|
| |
|
Tractor - Three Trailers: |
Yes |
|
Type Of Equipment: |
Van |
Tank |
Flat |
Dump |
Refer |
|
Dates: |
From:
MM/DD/YY
__To:
MM/DD/YY |
|
Aprox. Number Of
Miles: |
|
| |
|
Motor Coach - School
Bus more than 8 passengers |
Yes |
|
Type Of Equipment: |
Van |
Tank |
Flat |
Dump |
Refer |
|
Dates: |
From:
MM/DD/YY
__To:
MM/DD/YY |
|
Aprox. Number Of
Miles: |
|
| |
|
Motor Coach - School
Bus more than15 passengers |
Yes |
|
Type Of Equipment: |
Van |
Tank |
Flat |
Dump |
Refer |
|
Dates: |
From:
MM/DD/YY
__To:
MM/DD/YY |
|
Aprox. Number Of
Miles: |
|
|
Other: |
|
|
Training |
| States Operated in last
5 Years: |
|
| Special Courses or Training
That will help you as a driver: |
|
| Trucking, Transportation
or Other Expertise That may help in your work for this
company: |
|
| Courses and Other Training
not listed in this application: |
|
| Highest Grade Level Completed |
|
| Last School Attended |
|
| |
|
| By submitting this application you certifiy
the all entries on it and information in it are true and
complete to the best of my knowledge. |
|
By entering a valid email you agree with all terms on
this page. |
|
Please Click Submit only ONCE. |
