Employment

Please provide the following contact information:                      

 

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
E-mail
DOB
SSN
Date available to start
CDL License Number
CDL License State
CDL Expiration Date
	PRESENT/ MOST RECENT:
Employer
Dates of employment
Street Address
City
State
Telephone
Contact name
Reason for Leaving
	1st PREVIOUS:
Employer
Dates of employment
Street Address
City
State
Telephone
Contact name
Reason for Leaving
	2nd PREVIOUS:
Employer
Dates of employment
Street Address
City
State
Telephone
Contact name
Reason for Leaving
Number of years truck diving experience
Do you have the right to work in the United States?	yes  no
Have you worked for this company before?	yes  no
Have you ever been convicted of a felony?	yes  no
Has any license, permit or privilege ever been suspended?	yes  no
Any accidents in the past 3 years?	yes  no
If answer to any above is yes, please explain:
Has been convicted of traffic violation(s) in the past 3 years?	yes  no
If yes state Charge, Date, Location and Penalty:
Do you authorize Indian Valley Bulk Carriers, Inc. to request the Dept. of Transportation to furnish a copy of your Driver's Record?	yes   no

 

This form is a pre-application only and does not imply the offer of a position. At its own discretion, the company will contact candidates with whom it wishes to further the application process. I certify that I personally completed this form and that all of the information is true and correct. I authorize Indian Valley Bulk Carriers, Inc. to conduct a thorough background investigation, including a Driving Records Check if authorized on the form, in accordance with state and federal law and authorize my previous employers to release any information requested by Indian Valley Bulk Carriers, Inc. and hold them harmless of all liability from the release of said information. Also, in accordance with the provisions of 49 CFR Part 382.405 and 382.413, I hereby authorize and require my previous and/or current employers specifically listed by me on this application to release the results (including any refusal to test) of all drug and alcohol tests taken by me pursuant to the provisions of 49 CFR while in their employment to Indian Valley Bulk Carriers, Inc.  by whatever means is most expedient.