In compliance with Federal and State equal employment opportunity laws, qualified applications are considered for all positions without regards to race, color, religion, sex, national origin, age, or the presence of a non-job related medical condition or handicap.

 

Date
Position Seeking
Name
Address
Address
City
State
Zip
Email Address
How many years at present address?
List any previous addresses during
the last 5 years
Age                Date of birth , 19
Place of birth Height   Weight
Telephone  SS Number 

Are you a US Citizen? Yes  No
Have you ever been bonded?  Yes  No
If yes, on what job? 
Are you currently employed?  Yes No
Last Employer:  Include Company name, address, supervisor, position, reason for leaving, dates of employment

Second to Last Employer:  Include Company name, address, supervisor, position, reason for leaving, dates of employment

Third to Last Employer:  Include Company name, address, supervisor, position, reason for leaving, dates of employment

Education

Elementary
High School
College
Do you have a CDL?    Yes  No
Issuing State
License Number
Expiration

 

Class of Equipment Years of Experience Date From Date To; Approx. # of Miles
Straight Truck
Tractor/ Semi Trailer
Truck and Full trailer
Other

Vehicle Accident Record:  List date, location, property damage, personal injury or fatalities

Traffic Convictions: List name of court, location, date, charge, penalty

Have you been convicted of a felony within the past 10 years Yes  No
If yes please explain

In connection with my application for employment  (including contracts for services) with Continental Express, Inc., I understand that consumer reports and past employment history which may contain public record information may be requested by Continental Express, Inc., and DAC Services, Tulsa Oklahoma.  These reports may include the following types of information: names and dates of previous assessment of my job performance, ability, and attendance, and any other information requested as deemed necessary in evaluating my employment history.  I further understand that such reports may contain public record information concerning my driving record, workers' compensation claims, credit, bankruptcy proceedings, criminal records, etc..., from federal, state and other agencies which maintain such records; as well as information from my past employers and DAC concerning previous driving record requests made by others from such state agencies, and state provided driving records.

I authorize, without reservation, any party of agency contacted by Continental Express Inc.,  and DAC to furnish the above-mentioned 

I have the right to make a request to past employers and DAC, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me which past employers and DAC have previously furnished within the two period proceeding and DAC, and I agree that such information which my past employers and DAC have or obtains, and my employment history with you if I am hired, will be supplied by DAC to other companies which subscribe to DAC Services.

I hereby authorize procurement of consumer report(s) and past employment history.   If hired (or contorted), this authorized shall remain on file and shall serve as ongoing authorization for you to procure consumer reports and past employment history at any time during my employment.

"I have read and totally agree with the above information YES