test – Knight's Pumping and Portable Services

APPLICATION INFORMATION

Name *

Address *

Street Address Address Line 2 City State ZIP Code

Phone *

Email *

Date Available *

Driver's License *

Desired Salary

Position Applied for

Are you a citizen of the United States? *

Yes
No

Are you authorized to work in the U.S? *

Yes
No

Have you ever worked for this company? *

Yes
No

If so, when?

EDUCATION

High School *

Address *

Did you graduate? *

Yes
No

Degree *

College

Address

Did you graduate?

Yes
No

Degree

Other

Address

Did you graduate?

Yes
No

Degree

REFERENCES

Please list three professional references.

Full Name *

Relationship *

Company *

Phone *

Address *

Full Name *

Relationship *

Company *

Phone *

Address *

Full Name *

Relationship *

Company *

Phone *

Address *

PREVIOUS EMPLOYMENT

Company *

Phone *

Address *

Supervisor *

Job Title *

Responsibilities *

From *

To *

Reason for Leaving *

Were you subjected to the FMCSRs while employed? *

The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce 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.

Yes
No

May we contact your previous supervisor for a reference? *

Yes
No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? *

Yes
No

Company *

Phone *

Address *

Supervisor *

Job Title *

Responsibilities *

From *

To *

Reason for Leaving *

Were you subjected to the FMCSRs while employed? *

Yes
No

May we contact your previous supervisor for a reference? *

Yes
No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? *

Yes
No

Company *

Phone *

Address *

Supervisor *

Job Title *

Responsibilities *

From *

To *

Reason for Leaving *

Were you subjected to the FMCSRs while employed? *

Yes
No

May we contact your previous supervisor for a reference? *

Yes
No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? *

Yes
No

ACCIDENT REPORT FOR PAST 3 YEARS OR MORE (ATTACH SHEET IF MORE SPACE IS NEEDED).

Accident Report: How many accidents have you been in in the last 3 years? *

1- Please describe the accident including date, nature of accident, number of fatalities/injuries as well as any material spills

2- Please describe the accident including date, nature of accident, number of fatalities/injuries as well as any material spills

3- Please describe the accident including date, nature of accident, number of fatalities/injuries as well as any material spills

4- Please describe the accident including date, nature of accident, number of fatalities/injuries as well as any material spills

5- Please describe the accident including date, nature of accident, number of fatalities/injuries as well as any material spills

TRAFFIC CONVICTIONS AND FORFEITURES PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)

Traffic Convictions: How many Traffic Convictions have you been in in the last 3 years? *

1- Please describe the traffic convictions including Location, Date, Charge Penalty *

2- Please describe the traffic convictions including Location, Date, Charge Penalty *

3- Please describe the traffic convictions including Location, Date, Charge Penalty *

4- Please describe the traffic convictions including Location, Date, Charge Penalty *

5- Please describe the traffic convictions including Location, Date, Charge Penalty *

EXPERIENCE AND QUALIFICATIONS- DRIVER

Driver license or permits held in the past 3 Years *

1 - Please include license no, state, number, class, endorsement(s) and expiration date *

2 - Please include license no, state, number, class, endorsement(s) and expiration date *

3 - Please include license no, state, number, class, endorsement(s) and expiration date *

4 - Please include license no, state, number, class, endorsement(s) and expiration date *

5 - Please include license no, state, number, class, endorsement(s) and expiration date *

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

Yes
No

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

Yes
No

If the answer to either A or B is yes, give details

DRIVING EXPERIENCE CHECK YES OR NO

Class of Equipment

Straight Truck *

Yes
No

Type of Equipment

Dates (start date and end date)

Approx. Number of Miles (total)

Tractor and Semi-Trailer *

Yes
No

Type of Equipment

Dates (start date and end date)

Approx. Number of Miles (total)

Tractor and Two-Trailers *

Yes
No

Type of Equipment

Dates (start date and end date)

Approx. Number of Miles (total)

Tractor and Three-Trailers *

Yes
No

Type of Equipment

Dates (start date and end date)

Approx. Number of Miles (total)

Motor coach - School Bus +8 passengers *

Yes
No

Motor coach - School Bus +15 passengers *

Yes
No

Other *

Yes
No

List states operated in for last five years:

Show special courses or training that will help you as a driver:

Which safe driving awards do you hold and from whom?

EXPERIENCE AND QUALIFICATIONS - OTHER

Show any trucking, transportation or other experience that may help in your work for this company

List courses and training other than shown elsewhere in this application

List special equipment or technical materials you can work with (other than those already shown)

MILITARY SERVICE

Branch *

From *

To *

Rank at Discharge

Type of Discharge

If other than honorable, explain

DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release

Signature

Date