Form For EmploymentA Drug Free WorkplaceAn Equal Opportunity Employer
Name (Last, First Middle):
E-Mail Address:
Phone Number:
Present Address:
Position Applied For: Choose Position Trans-Fuel Tank Driver
Referred By:
Names Of Friends or Relatives Employed by This Company:
Are you wiling to work nights and weekends?
Yes No
Are you over 18?
Are you employed now?
Have you ever worked for the Company before?
Do you have any gasoline tanker experience?
If hired, do you have a reliable means of transportation?
Can you, upon employment, submit verification of your legal right to work in this country?
Has your drivers license ever been suspended?
Number of traffic citations in last 5 years
Number of traffic accidents in last 5 years
Have you ever been convicted of a crime? (In answering this question, do not include convictions in excess of two (2) yearsold relating to possession or use of an ounce or less of marijuana, nor any misdemeanor conviction for which probation has been completed. Note: a conviction will not necessarily disqualify you from the postition applied for.)
Yes No If yes, please explain in the area below.
Education: --- Select One --- Grammar School - 1 Grammar School - 2 Grammar School - 3 Grammar School - 4 Grammar School - 5 Grammar School - 6 Grammar School - 7 Grammar School - 8 High School - 9 High School - 10 High School - 11 High School - 12 College - 1 College - 2 College - 3 College - 4 College - 5 Name of last school attended:
Previous Work History (list 4):
Employer: Employment Dates: to Position: Responsibilities: Salary: Reason for Leaving:
Are you able to perform all essential functions of the job for which you are applying?
Yes No If no, explain below.
Are you able to perform all other duties of the job for which you are applying?
The area below is provided for you to explain anything regarding the above questions.
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