Employee Application

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.

TO BE READ AND SIGNED BY APPLICANT

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.

I understand that information I provide regarding current and/or previous 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(d) and (e). I understand I have the right to:

• Review information provided by previous employers.

• 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.

Address *

Apt, suite, etc.

Country

City

State

Zip code

Are you eligible to work in the United States? *

Yes

Are you able to be away from home for extended periods of time? *

Yes

Do you have any limitations that preclude you from performing any work for which you will are being considered? *

Yes

If \"Yes\", please describe *

In case of emergency, please notify:

Position(s) Interested In *

Rate of Pay Expected *

Have you been employed with us before? *

Yes

List friends or relatives that work for us *

Felony *

Yes

Have you ever been convicted of a felony?

Felony Details *

If yes, please explain fully. Conviction of a crime is not an automatic bar to employment.

Special Training/Certificates *

List any special skills, machines, equipment, experiences, or training that you possess that may be related to the job for which you are applying: *

Truck Driver - Heavy Equip *

Equipment Operator *

Welder (State Cert.) *

Please list types of equipment *

Valid Drivers License? *if CDL is selected, you must complete the CDL portion of this application *

Regular

CDL

None

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

Yes

If \"Yes\", provide details *

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

Yes

If \"Yes\", provide details *

Endorsements *

H - hazardous material

P - transport 16+ people

N - liquid or gaseous material

S - school Bus

M - motorcycle

T - tow double/triple trailers

All applicants must provide the following information on all employers during the past three (3) years. Applicants to drive a commercial motor vehicle shall also provide an additional seven (7) years information. Complete mailing address, street number, city, state, and zip code are required. There can be no gaps in employment.

Hourly Rate / Salary *

Reason for Leaving *

While employed by this employer, were you subject to the Federal Motor Carrier Safety Regulations? *

Yes

Was this job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40? *

Yes

Hourly Rate / Salary *

Reason for Leaving *

While employed by this employer, were you subject to the Federal Motor Carrier Safety Regulations? *

Yes

Was this job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40? *

Yes

Hourly Rate / Salary *

Reason for Leaving *

While employed by this employer, were you subject to the Federal Motor Carrier Safety Regulations? *

Yes

Was this job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40? *

Yes

Only complete this section if you will be asked to drive for Diesel Dogs Trucking.
If you are asked to drive for Diesel Dogs Trucking Service you are required to list any traffic violations you have had in the past 3 years. I certify the following is a true and complete list of traffic violations (other than parking tickets) for which i have been certified or forfeited bond or collateral.

Have you had any traffic violations in the past three years? If \"Yes\", please describe *

Yes

Type of vehicle operated *

Have you had any motor vehicle accident in the past three years? If \"Yes\", please describe *

Yes

Nature of Accident: (head on, rear end, etc.) *

Fatalities / Injuries / Property Damage *

Nature of Accident: (head on, rear end, etc.) *

Fatalities / Injuries / Property Damage *

Have you ever been convicted of a misdemeanor or felony? If \"Yes\", please describe *

Yes

* Convictions are not an absolute bar to employment, but will be considered in relationship to the job requirements.

Complete this portion of the application if you have a CDL or have operated a commercial motor vehicle.

Have you ever tested positive or refused to be tested on a Pre-Employment Drug Screen for an employer that you did not go to work for? *

Yes

If Yes, Name of Employer *

Previous Addresses

Please list all address you have resided during the past three (3) years.

Address *

Apt, suite, etc.

Country

City

State

Zip code

Address *

Apt, suite, etc.

Country

City

State

Zip code

Class of Equipment *

Approx. # of miles (total) *

Class of Equipment *

Approx. # of miles (total) *

Class of Equipment *

Approx. # of miles (total) *

This company is committed to an Affirmative Action Program which includes giving full consideration for employment to qualified handicapped individuals, Vietnam-era veterans, disabled veterans, ethnic minorities and women. The following information is being requested for all applications for employment. Your providing this information is strictly VOLUNTARY. This self-identification request is made in compliance with the AFFIRMATIVE ACTION PROGRAM and to aid in complying with any required Governmental record keeping or periodic reporting.

This information is NOT part of your employment application, and will not be considered in the employment selection process. If you choose to provide the information please complete the following:

Referral Source *

Walk In

Government Employment Agency

Employee

Private Employment Agency

Relative

Advertisement-Source

School

Job Service

Union

Facebook

Craigslist

Website

Other

Name of person who referred you (if applicable) *

Race *

White-origins in Europe, North Africa or Middle East

Asian-origins in Far East, SE Asia, India or Pacific Island

Black-origins in Africa

Hispanic-Mexican, Puerto Rican, Cuban, Central or South America

American Indian-origins in North America, to include Alaska

Veterans/Military Status *

Non-Veteran

Pre-Vietnam Veteran with Service Incurred disability

Pre-Vietnam Veteran

Vietnam Era Veteran (8/5/64 – 5/7/75)

Vietnam Era Veteran with Service Incurred disability

Post Vietnam Veteran

Post Vietnam Veteran with service incurred disability

Active National Guard Reservist *

Physical Condition *

No Disability

Physical Disability (No Facility Modification)

Physical Disability (Facility Modification)

Health Disability (Heart Attack, Diabetic, Epileptic Etc.)

Mentally Disabled (Learning Disabled)

Instructions

I authorize you to make sure investigations and inquiries to 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.

“I understand that information I provide regarding current and/or previous 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(d) and (e). I understand that I have the right to:

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