Thank you for taking the time to fill out our application


First Name * (* = Manditory)
Last Name *
Social Security Number * (no dashes please)
Date of Birth* (format MM/DD/YY)
Mailing Address*
City*State *Zip *
Phone Number*
Cell Phone (No punctuation in phone numbers)
Pager Phone
Email Address

Best time to be reached
Best way to be reached in next hour

Class A CDL Number   State    Exp Date

* Experience in:
Van Flatbed Other

Preventable Accidents Last Three Years  0 1 2 3 4 5 6 7 8 9   *
Moving violations last three years  0 1 2 3 4 5 6 7 8 9 *

Ever have a Revoked or Suspended License No Yes   *
If yes, How Long Ago (years) 0 1 2 3 4 5 6 7 8 9   *

DUI or DWI Citations No Yes   *
If yes, How Long Ago (years) 0 1 2 3 4 5 6 7 8 9 *

Felony Convictions No Yes   *
If yes, How Long Ago (years) 0 1 2 3 4 5 6 7 8 9   *

Ever tested positive for a controlled substance No Yes   *
If yes, How Long Ago (years) 0 1 2 3 4 5 6 7 8 9   *

Number of jobs in past 3 years 0 1 2 3 4 5 6 7 8 9   *

Make of Tractor  * Year of Tractor *

Current Employment Information

Current Employer:
May we contact now            No Yes

City       State  
Telephone
Position Held
Supervisor
Type of Trailer
Over the road or local:    Over the Road Local

Date From


Past Employment Information
First Previous Employer:
May we contact now No Yes

City        State 
Telephone
Position Held
Supervisor
Type of Trailer
Over the road or local: Over the Road Local

Date From         Date to

Reason for leaving



Second Previous Employer:
May we contact now No Yes

City      State 
Telephone
Position Held
Supervisor
Type of Trailer
Over the road or local: Over the Road Local

Date From         Date to

Reason for leaving
 


Third Previous Employer:
May we contact now No Yes

City        State 
Telephone
Position Held
Supervisor
Type of Trailer
Over the road or local: Over the Road Local

Date From         Date to

Reason for leaving

 

Fourth Previous Employer:
May we contact now No Yes

City        State 
Telephone
Position Held
Supervisor
Type of Trailer
Over the road or local: Over the Road Local

Date From         Date to

Reason for leaving



Fifth Previous Employer:
May we contact now No Yes
.
City        State 
Telephone
Position Held
Supervisor
Type of Trailer
Over the road or local: Over the Road Local

Date From         Date to

Reason for leaving


* By Checking this button and clicking submit on this electronic application, I certify that I personally completed this application and that all of the information is true and correct.
I hereby request and authorize Lumber Transport, Inc. to conduct an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, mode of living, criminal history, past work experience, educational background, alcohol drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. In connection with my application, I understand that consumer reports which may contain public record information may be obtained. I understand that the completion of this form does not assure me of a position with Lumber Transport, Inc. or obligate the Company in any way.

      

version 1.1 Copyright 2008 Lumber Transport Inc as work in progress. All rights reserved world wide.