Truck Driver Employment Application - Cardella Waste Services

Driver’s Application for Employment

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, non-job related disability, or any other protected group status.

Personal Information
Name*
First Middle Last
Phone Number*
Email Address*
Date of Birth*
Date Format: MM slash DD slash YYYY
Current Address
Street Address Address Line 2 City State ZIP Code
Time at current address

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Previous Residence 1
Address
Street Address Address Line 2 City State ZIP Code
Time at this address
Previous Residence 2
Address
Street Address Address Line 2 City State ZIP Code
Time at this address
Are you legally permitted to work in the United States?*
- Yes
- No

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Employment History
Were you previously employed by Cardella Trucking Co., Inc?*
- Yes
- No
Previously employed by Cardella from
Date Format: MM slash DD slash YYYY
Previously employed by Cardella until
Date Format: MM slash DD slash YYYY
Previous Position
Previous Rate of Pay
Reason for Leaving
Are you currently employed?*
- Yes
- No
Previously employed from
Date Format: MM slash DD slash YYYY
Previously employed until
Date Format: MM slash DD slash YYYY

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Previous/Current Employer
All applicants must provide ten (10) years information on those employers for whom the applicant operated commercial motor vehicles (i.e., vehicles having a GVWR of 26,001 lbs or more, vehicles designated to transport fifteen (15) or more passengers, or any size vehicle used to transport hazardous materials in quantity requiring placarding).
Employer Name
Do you currently work here?
- I am currently employed here
Employer Address
Street Address Address Line 2 City State ZIP Code
Contact Person
First Last
Did you drive a vehicle requiring a CDL?
- Yes
- No
Date you started working here
Date Format: MM slash DD slash YYYY
Date you stopped working here
Date Format: MM slash DD slash YYYY
Position Held
Salary Wage
Reason for leaving
Previous Employer 2
Employer Name
Employer Address
Street Address Address Line 2 City State ZIP Code
Contact Person
First Last
Did you drive a vehicle requiring a CDL?
- Yes
- No
Date you started working here
Date Format: MM slash DD slash YYYY
Date you stopped working here
Date Format: MM slash DD slash YYYY
Position Held
Salary Wage
Reason for leaving
Previous Employer 3
Employer Name
Employer Address
Street Address Address Line 2 City State ZIP Code
Contact Person
First Last
Did you drive a vehicle requiring a CDL?
- Yes
- No
Date you started working here
Date Format: MM slash DD slash YYYY
Date you stopped working here
Date Format: MM slash DD slash YYYY
Position Held
Salary Wage
Reason for leaving

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Referrals
Name Phone
Expected rate of pay

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Criminal Background
Have you ever been convicted of a felony?*
- Yes
- No
Please explain fully
Conviction of a crime is not an automatic bar to employment. All circumstances will be considered.
Other
Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the attached job description?*
- Yes
- No
Please explain

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Driving Record
Motor Vehicle Accidents Record
- I have not been involved in any motor vehicle accidents in the past three (3) years.
Please list details about motor vehicle accident(s) you've been involved in
Date Nature of Accident (head-on, rear-end, upset, etc.) Fatalities Injuries

You can use the +/- buttons above to add more entries.
Traffic Convictions and Forfeitures
- I have not been involved with any traffic convictions and/or forfeitures for the past three (3) years (other than parking violations).
Please list details about the convictions and/or forfeitures
Location Date Charge Penalty

You can use the +/- buttons above to add more entries.
Experience and Qualifications - Driver
Driver Licenses
State Last 4 Digits of License Number Type Expiration Date
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?*
- Yes
- No
Explain Why
Has any license, permit, or privilege ever been suspended or revoked?*
- Yes
- No
Explain Why

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I have experience driving:
- Straight Truck
- Tractor and Semi-Trailer
- Tractor with Two Trailers
- Motorcoach/School Bus
- Other
Straight Truck Experience
Type of Equipment (Van, Tank, Flat, etc.) Dates (from - to) Approx. No. of Miles (total)
Tractor and Semi-Trailer Experience
Type of Equipment (Van, Tank, Flat, etc.) Dates (from - to) Approx. No. of Miles (total)
Tractor with Two Trailers Experience
Type of Equipment (Van, Tank, Flat, etc.) Dates (from - to) Approx. No. of Miles (total)
Motorcoach/School Bus Experience
Type of Equipment (Van, Tank, Flat, etc.) Dates (from - to) Approx. No. of Miles (total)
Other Experience
Type of Equipment (Van, Tank, Flat, etc.) Dates (from - to) Approx. No. of Miles (total)

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Experience and Qualifications - Other
Describe 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 described)
To be Read and Signed by Applicant
Please put a check next to each statement if you agree.
Question 1*
- This certifies that this application was completed by me, and that all entered on it and information in it are true and complete to the best of my knowledge.
Question 2*
- I authorize you to make such investigation and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended).
Question 3*
- I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.
Question 4*
- In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.
Signature*
Please type out your entire name. This serves as your signature.

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Employment

Driver’s Application for Employment

Step 1 of 11

Personal Information

Previous Residence 1

Previous Residence 2

Employment History

Previous/Current Employer

Previous Employer 2

Previous Employer 3

Criminal Background

Other

Driving Record

Experience and Qualifications - Driver

Education History

Experience and Qualifications - Other

To be Read and Signed by Applicant

Date	Nature of Accident (head-on, rear-end, upset, etc.)	Fatalities	Injuries

Type of Equipment (Van, Tank, Flat, etc.)	Dates (from - to)	Approx. No. of Miles (total)

Name	Phone

Location	Date	Charge	Penalty

State	Last 4 Digits of License Number	Type	Expiration Date