• Applicant Name*
  

• Home Phone
  

• Email*
  

• Current Address
  

• Cell Phone*
  

• Position Applying For*
  

• Job Type
  TemporaryFull TimePart Time

• Who referred you
  

• Rate of pay expected
  

• Have you ever worked for this company before
  NoYes

• Dates
  FromTo

• Where
  

• Rate
  

• Position
  

• Reason for leaving
  

• Name of relatives employed by this company
  

• Are you currently employed
  YesNo

• If not, How long since last employment
  

• Education

• Circle highest grade completed
  123456789101112

• College
  1234

• Last school attended

• Name
  

• Address
  

• Military Experience

• Have you served in the U.S. armed forces
  YesNo

• If Yes, Which Branch of service
  

• Describe any military training received relevant to the position for which you are applying
  

• Are you currently serving in military reserves
  YesNo

• Are you currently serving in the nation guard
  YesNo

• General

• Have You ever been bonded Answer only if a job requirement
  YesNo

• Name of bond company
  

• Have you ever been convicted of a felony
  YesNo

• If yes, Please explain below. Conviction of a crime is not an automatic bar to employment- all circumstances will be considered
  

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• DRIVER EXPERIENCE AND QUALIFICATOIN

• The federal motor carrier safety regulation (49CFR391.21 (B) (2) require that driver applicants state their date of birth and SS #.

• Date of Birth
  

• Social Security Number

• Physical History

• The federal motor carrier safety regulation (49CFR391 Subpart E) requires that all driver applicants pass certain physical tests before they are hired to drive a motor vehicle.
  Date of last department of transportation prescribed examination

• Can you provide copyYesNo

• Alcohol and Controlled substance statement

• The federal motor carrier safety regulation 49CFR40.25(j) requires all person with applying for a driving position requiring a commercial drivers licence to answer the following questions:

• 1. With the last two years, have you ever tested positive, or refused to test, on any pre employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety sensitive transportation work?YesNo

• 2.Within the last two years, have you ever tested positive, or refused to test, on any type of drug or alcohol test administered by an employer for which you preformed safety-sensitive transformation workYesNo

• 3. If you answered yes to either 1 or 2 above, can you provide and / or obtain proof that you have successfully completed the DOT return-to-duty requirements?
  YesNo

• Applicant Signature:

• Date:

• Witnessed By:

• Date:

• Driver's Licence Information

• Driver Licenses held in past 3 years must be shown

• State

  License

  Type

  Expiration Date

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

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

• C. Have you ever been disqualified for voilations of the federal motor carrier safety requlations?
  YesNo

• List states operated in during the last five years:
  

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

• List safe driving awards held and who awards were presented by:
  

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• DRIVER EXPERIENCE AND QUALIFICATIONS

• ACCIDENT HISTORY

• Accident Review for the past 3 years ( attach a separate sheet of paper if more if more space is needed)

• Date

  Nature of Accident ( Head-on,Rear-End,Upset,etc)

  #Fatalities

  #Injuries

  #Vehicles Towend

  Citation Issued?

• MOTOR VEHICLE DRIVING RECORD (MVR)

• Traffic Convictions and Forfeitures for the past 3 years other than parking violation.

• Date

  Location

  Charge

  Penalty

• If hired by BG's Big Box Service and getting paid cash per week, You will not be covered any workers compensation insurance or any claims while getting paid with cash from Big Box Service.

• EMPLOYMENT RECORD

• The federal motor carrier safety regulations (49CFR391.21) Require that all applicants wishing to drive a commercial vehicle list all Employment for the last three (3)years. In additions, if you have driven a commercial vehicle previously, you must provide employment History for an additional seven (7)years for a total of ten (10)years. Any gaps in employment must be explained.

• Start with the last or current position, including any military experience, and work back (attach separate sheet if necessary) You are required to list the complete mailing address: street number, city state and zip code.

• Current Employer

• Supervisor's Name

• Address

• Phone

• Position Held

• From

• To

• Previous Employer

• Supervisor's Name

• Address

• Phone

• Position Held

• From

• To

• Previous Employer

• Supervisor's Name

• Address

• Phone

• Position Held

• From

• To

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• APPLICANT MUST READ AND SIGN

• I certify that I have read and understand all of this employment application. It is agreed and understood that the employer or his Agents may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether Same is of record or not, and applicant releases employers and other persons named herein from all liability for any damages on Account of his furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to Demonstrate that I am capable of performing tasks that are pertinent to the job.

• It is also agreed and understood that under the fair credit reporting act, public Law 91-508, I have been told that this investigation May include an investigative consumer report, including information regarding my character, personal reputation, personal Characteristic and mode of living.

• Is there any physical reasons why you would not be able to perform a driving job position at BG's Big Box Service, If yes, Please provide
  Reason why.
  

• I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

• I also understant that misrepresentation or omission of information or facts may result im my rejection or dismissal. If hired, agree to abide by all the rules and policies of the employer.

• This certifies that I completed this application and tha all entries on it and information in it are true and complete to the best of My konwledge.

• Resume:

• Date:

• Applicant's Signature:

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