Career Form - Quail Construction, LLC

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Careers Application Form

APPLICANT INFORMATION

Name

FIRST NAME MIDDLE NAME LAST NAME

PHONE

E-MAIL ADDRESS

DATE OF APPLICATION

MM slash DD slash YYYY

POSITION APPLYING TO

DATE AVAILABLE

MM slash DD slash YYYY

CURRENT ADDRESS

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

LICENSE INFORMATION

No person who operates a commercial motor vehicle shall at any time have more than one (1) driver's license (49 CFR 383.21). I certify that I do not have more than one (1) motor vehicle license, the information for which is listed below. Include all licenses held for the past three (3) years; attach additional sheets if needed.

State

License #

Type/Class

Endorsements

Expiration Date

PREVOIUSLY HELD LICENSES

State

License #

Type/Class

Endorsements

Expiration Date

DRIVING EXPERIENCE

STRAIGHT TRUCK

TYPE OF EQUIPMENT (VAN, TANK, FLAT, ETC.)

DATE FROM

MM slash DD slash YYYY

DATE TO

MM slash DD slash YYYY

APPROXIMATE # OF MILES (TOTAL)

TRACTOR & SEMI-TRAILER

TYPE OF EQUIPMENT (VAN, TANK, FLAT, ETC.)

DATE FROM

MM slash DD slash YYYY

DATE TO

MM slash DD slash YYYY

APPROXIMATE # OF MILES (TOTAL)

TRACTOR & 2 TRAILERS

TYPE OF EQUIPMENT (VAN, TANK, FLAT, ETC.)

DATE FROM

MM slash DD slash YYYY

DATE TO

MM slash DD slash YYYY

APPROXIMATE # OF MILES (TOTAL)

TRACTOR & TANKER

TYPE OF EQUIPMENT (VAN, TANK, FLAT, ETC.)

DATE FROM

MM slash DD slash YYYY

DATE TO

MM slash DD slash YYYY

APPROXIMATE # OF MILES (TOTAL)

OTHER

TYPE OF EQUIPMENT (VAN, TANK, FLAT, ETC.)

DATE FROM

MM slash DD slash YYYY

DATE TO

MM slash DD slash YYYY

APPROXIMATE # OF MILES (TOTAL)

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

No

Yes

Please explain:

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

No

Yes

Please explain:

EMPLOYMENT HISTORY

CURRENT {MOST RECENT) EMPLOYER

COMPANY NAME

Phone

COMPLETE ADDRESS

POSITION HELD

FROM MO/YR

TO MO/YR

REASON FOR LEAVING

SECOND (MOST RECENT) EMPLOYER

COMPANY NAME

Phone

COMPLETE ADDRESS

POSITION HELD

FROM MO/YR

TO MO/YR

REASON FOR LEAVING

THIRD {MOST RECENT) EMPLOYER

COMPANY NAME

Phone

COMPLETE ADDRESS

POSITION HELD

FROM MO/YR

TO MO/YR

REASON FOR LEAVING

EDUCATION

High School

NAME & LOCATION

COURSE OF STUDY

YEARS COMPLETED

GRADUATE

Yes

No

DETAILS

College

NAME & LOCATION

COURSE OF STUDY

YEARS COMPLETED

GRADUATE

Yes

No

DETAILS

Other

NAME & LOCATION

COURSE OF STUDY

YEARS COMPLETED

GRADUATE

Yes

No

DETAILS

OTHER QUALIFICATIONS

Please list any other qualification you have and which you believe should be considered.

I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, and other related matters as may be necessary in arriving at an employment decision. 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 also understand that I am required to abide by all rules and regulations of the Company. I understand that the information I provide regarding my current and/or prior employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23. I understand that I have the right to: • Review information provided by current/previous employers; • Have errors in the information corrected by previous employers, and for those previous employers to resend the corrected information to the prospective employer; and • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information. This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

APPLICANT PRINTED NAME

Date

MM slash DD slash YYYY

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