Driver Application for Employment

Century Fence Company is an equal opportunity/affirmative action employer. All qualified applicants will be considered without regard to age, race, color, sex, national origin, marital status, ancestry, citizenship, veteran status, sexual orientation or preference, or physical or mental disability. If you need assistance to complete this form or any part of the employment process, please notify the person that gave you the form and every effort will be made to accommodate your needs in a reasonable amount of time.

Personal Information

Name

First Middle Last

Address

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone

Are you atleast 18 years old?

Yes

If not, your employment will be subject to verification that you meet state/federal minimum age requirements for the type of work you are applying for and have obtained a valid work permit.

Are you legally authorized to work in the U.S.

First Choice

Second Choice

Third Choice

(If hired, you will be required to provide proof of work authorization)

Employment Objective

Position Desired

Wage Desired

Per Hour

Salary

Wage Desired $

What source led you to apply?

Other

Referred By

Education

Highschool (Name & City, State)

Major

Graduate/Years Completed

Diploma/Degree Type

Undergraduate (Name & City, State)

Major

Graduate/Years Completed

Diploma/Degree Type

Graduate (Name & City, State)

Major

Graduate/Years Completed

Diploma/Degree Type

Other Schools (Trade, Etc.)

Major

Graduate/Years Completed

Diploma/Degree Type

Additional Licensing

Type

Date Issued

Date Expired

Issuing State/Org.

Employment History

All applicants wishing to drive in interstate commerce must provide the following information on all employers during the preceding three years. You must give the same information for all employers for whom you have driven a commercial vehicle seven years prior to the initial three years (total often year employment record). Any gaps in employment must be explained. You are required to list the complete mail address: street number, city, state, zip code

Employer

Address

Street Address Address Line 2 City State ZIP Code

Supervisor Name

Supervisor Phone

Start Date

End Date

Work Performed

Reason for Leaving

Explain Period Between Jobs (Include Dates & Reason)

Did you Drive Vehicle Requiring a CDL?

Yes

Employer

Address

Street Address Address Line 2 City State ZIP Code

Supervisor Name

Supervisor Phone

Start Date

End Date

Work Performed

Reason for Leaving

Explain Period Between Jobs (Include Dates & Reason)

Did you Drive Vehicle Requiring a CDL?

Yes

Employer

Address

Street Address Address Line 2 City State ZIP Code

Supervisor Name

Supervisor Phone

Start Date

End Date

Work Performed

Reason for Leaving

Explain Period Between Jobs (Include Dates & Reason)

Did you Drive Vehicle Requiring a CDL?

Yes

Employer

Address

Street Address Address Line 2 City State ZIP Code

Supervisor Name

Supervisor Phone

Start Date

End Date

Work Performed

Reason for Leaving

Explain Period Between Jobs (Include Dates & Reason)

Did you Drive Vehicle Requiring a CDL?

Yes

Driving Experience

Class of Equipment

Type of Equipment (Van, Tank, Flat, etc.

Start Date

End Date

Approx. No. of Miles Total

If none, write the word “none”

Accident history (3 Years)

Dates

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

Fatalities

Injuries

If none, write the word “none”

Traffic Convictions and Forfeitures

Location

Date

Charge

Penalty

If none, write the word “none” (Do not include parking violations)

License Information

Unexpired License- Section 383.21 FM CSR states “No person who operates a commerical vechiles shall at any time have more than one driver license.” certify that I do not have more than one motor vehicle license, the information for which is listed below.

State

License Number

Type

Exp. Date

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

Give Details

Has any license, permit, or privilege ever been suspended or revoked?

Give Details

General Questions

Have you ever been employed by Century Fence Company or its affiliates before?

Do you have any relatives employed by Century Fence Company or its affiliates?

Are you currently working for another employer?

At this time, do you intend to woork for another employer if employed by this company?

If hired, will you be able to work overtime?

Additional Information: Please use the area below to identify any skills or knowledge you possess which you feel would be applicable to your success with Century Fence Company if hired:

Certification & Authorization

The above information is true and correct. I understand that, in the event of my employment by Century Fence Company I shall be subject to dismissal if any infonnation that I have given in this application is false or misleading or if I have failed to give any infonnation herein requested, regardless of the time elapsed after discovery.

I authorize Century Fence Company to inquire into my educational, professional, and both current and past employment as needed to research my qualifications for this position. I hereby give my consent to any fonner employer to provide employment-related infonnation about me to Century Fence Company and will hold Century Fence Company and my former employer harmless from any claim made on the basis that such infom1ation about me was provided or that any employment decision was made on the basis of such information. I further authorize Century Fence Company to obtain a criminal background check, and a driver’s license check if this is relevant to the position for which I am applying.

I understand that nothing in this employment application, the granting of an interview, or my subsequent employment with Century Fence Company is intended to create an employment contract between myself and Century Fence Company. I understand and agree that, if hired, my employment will be tenninable at will and may be tenninated by me or Century Fence Company at any time and for any reason. I understand that no person has any authority to enter into any agreement contrary to the foregoing.

I understand that any employment offer that is made will be conditional until I have successfully provided original documents that verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for completion of Fonn 1-9. Additionally, any offer of employment will be conditional until I have submitted to a physical examination to determine my fitness for the position and a controlled substance test.

I hereby acknowledge that I have read and agree to the above statements.

Signature

Date

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Driver Application for Employment