subject_line
Join Our Team
Personal Information
First Name
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Last Name
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Address 1
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Address 2
City
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State
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Zip Code
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Phone (123-456-7890)
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Email Address
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Date of Birth (MM/DD/YYYY)
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Driver's License State
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AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Driver License Number
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Drivers License Expires (MM/DD/YYYY)
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Class A Endorsement?
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Yes
No
How many years have you had your CDL?
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Social Security # (555-55-5555)
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Position Applying For
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Driver (Out 2 weeks at a time-most profitable)
Driver (Home every weekend)
Owner Operator
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
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Yes
No
Has any license, permit or privilege ever been suspended or revoked?
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Yes
No
If yes, please explain.
Employment History
*********************CURRENT EMPLOYER***********************
Company Name
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Based out of what City/State?
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Phone
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Start Date (MM/DD/YYYY)
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End Date (MM/DD/YYYY)
*
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Position
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Class A CDL required/used?
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YES
NO
Type of Trailer Pulled?
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Supervisor/Manager
Reason for Leaving
*
************************************ PREVIOUS EMPLOYER ************************************
Company Name
*
Based out of what City/State?
*
Phone
Start Date (MM/DD/YYYY)
*
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End Date (MM/DD/YYYY)
*
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Position
*
Class A CDL required/used?
*
YES
NO
Type of Trailer Pulled?
Supervisor/Manager
Reason for Leaving
******************************** PREVIOUS EMPLOYER ******************************
Company Name
*
Based out of what City/State?
*
Phone
Start Date (MM/DD/YYYY)
*
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End Date (MM/DD/YYYY)
*
+
Position
*
Class A CDL required/used?
*
YES
NO
Type of Trailer Pulled?
Supervisor/Manager
Reason for Leaving
Drving Experience
List special courses or training that will help you as a driver:
Which safe-driving awards do you hold and from whom?
End Dump TRAILER Experience
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YES
NO
If you do have end dump trailer experience, how many years approximately have you pulled an end dump?
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Tractor/Trailer Experience (Van, Tank, Flatbed, End Dump, etc)
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Less than 1 year
1 to 2 years
3 years or more
Straight Truck Experience?
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Less than 1 year
1 to 2 years
3 years or more
Accidents
List ALL Accidents. Note the nature of the accident, if there were any fatalities or injuries.
How did you hear about Glaser Williams/J K Williams?
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Word of Mouth (another Driver)
Facebook/Social Media
Saw our Trucks/Trailers
Radio
Do you give J K Williams LLC authorization to run your motor vehicle report (MVR) to assist in determining eligibility?
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YES
NO
Do you give J K Williams LLC authorization to run a Pre-Employment Screening Program (PSP) report to assist in determining eligibility?
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YES
NO
Signature
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clear
Today's Date (MM/DD/YYYY)
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