Reinsfelder Trucking, Inc Employment Application - Online Form

Type of Application*

Name*

FirstLast

Email*

Date of Application*

Social Security Number*

Address*

Street AddressAddress Line 2CityStateZip Code

Home Phone*

Cell Phone*

Date of Birth*

Have you ever been convicted of a felony?*

If YES, what was the year of the felony?

If YES, what type of conviction:

Have you ever been convicted of a DUI or controlled substance?*

If YES, what was the year of the conviction?

If YES, what type of conviction?

Have you ever tested positive on a drug screening exam?*

Are you capable of performing heavy manual labor and tarping steel and machines?*

Do you have any Over-The-Road (OTR) experience?*

If YES, how many years?

Do you have any flatbed experience?*

If YES, how many months?

CDL#*

State*

Endorsements

Expiration Date

Number of tickets in the last 5 years:*

Number of accidents in the last 5 years*

Employment History

Please list employers for the last 3 years in the sections below:

Most Recent Employer*

From (Date)*

To (Date)*

Employer Address*

Street AddressAddress Line 2CityStateZip Code

Employer Phone*

List types of trailers used*

May we contact this employer?*

Rate of Pay:*

Why did you leave/do you wish to leave?*

Next Most Recent Employer

From (Date)

To (Date)

Employer Address

Street AddressAddress Line 2CityStateZip Code

Employer Phone

List types of trailer used:

May we contact this employer?

Rate of Pay:

Why did you leave?

Next Most Recent Employer

From (Date)

To (Date)

Employer Address

Street AddressAddress Line 2CityStateZip Code

Employer Phone

List types of trailer used:

May we contact this employer?

Rate of Pay:

Why did you leave?

Signature

By submitting online form via email, this certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge, I authorize REINSFELDER, INC. to make such investigations 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.) I hereby release employers, schools, healthcare providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application. I understand that information I provide regarding current and/or previous employers may be used and those employer(s)will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23 (a) and (e). I understand that I have the right to: * Review information provided by previous employers * Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer * Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the Information In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the company. To release the following information to Reinsfelder, Inc. for the purposes of investigation as required by section §391.23 and allowed by section §383.35 of the Federal Motor Carrier Safety Regulations. You are released from any and all liability, which may result from furnishing such information.

Name:*

Today's Date:*