Employment at Jespersen Trucking - Online Driver Application Form

[ Home ] [ About ] [ Rates ] [ Performance ] [ Contact ] [ Employment ] [ Privacy ]

Employment Application

General Information
Position Desired		Local Driver	Owner Operator
Owner Operator Equipment Information
Year:	Make:	Model:	Weight:
Tandem: Yes No		Sleeper: Yes No
Referral Source:
Advertisement	Employee	Relative	Employment Agency
Walk-in	Private Employment Agency		Other
Personal Information
Last Name:		First	Middle Initial:
Address:

City:		Prov:	Postal Code:
Date of Birth:
Home Phone:		Mobile/Beeper/Other:
If necessary, best time to call you at home:
May we call you at work?Yes No
If yes, work number and best time to call:
Have you applied here before?		Yes	If yes, when?
Date available for work:
List each Driver's License held in the last 3 years:
	Driver's License Number:		Province:
	Driver's License Number:		Province:
	Driver's License Number:		Province:
Employment Information
Give a COMPLETE RECORD of all employment in the past 3 years, starting with the most recent, and all commercial driving experience for the past 10 years. Explain any gaps in employment in the comments section below.
Most Recent Employer
Employer:
Address:

City:	Province:		Postal Code:
Phone:
Supervisor:		May we contact?	Yes
Dates Employed:	to
Position:		Ending Pay Rate:
Responsibilities:
Reason for Leaving:
Second Most Recent Employer
Employer:
Address:

City:	Province:		Postal Code:
Phone:
Supervisor:		May we contact?	Yes
Dates Employed:	to
Position:		Ending Pay Rate:
Responsibilities:
Reason for Leaving:
Third Most Recent Employer
Employer:
Address:

City:	Province:		Postal Code:
Phone:
Supervisor:		May we contact? Yes
Dates Employed:	to
Position:		Ending pay Rate:
Responsibilities:
Reason for Leaving:
Fourth Most Recent Employer
Employer:
Address:

City:	Province:		Postal Code:
Phone:
Supervisor:		May we contact? Yes
Dates Employed:	to
Position:		Ending Pay Rate:
Responsibilities:
Reason for Leaving:
Comments (include explanation of any gaps in employment):

Skills and Qualifications: Summarize any special training, skills, license and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

Safety Record
Please list any Safe Driving Awards that you hold and from whom:

Please give details of any accidents in which you were involved in the last 3 years. Include dates, nature of accident (head on, rear-end, upset, etc.), number of injuries, number of fatalities. If none, type "NONE."

Please give details of all traffic convictions and forfeitures for the last 3 years. If none, type "NONE."

Have you ever been denied a license, permit, or privilege to operate a motor vehicle? NoYes
If "yes," please give details in the box below.

References
List name and telephone number of 3 business/work references who are NOT related to you and are NOT previous supervisors. If not applicable, list 3 school or personal references who are not related to you.
Reference 1
Name:
Phone:
Years Known:
Reference 2
Name:
Phone:
Years Known:
Reference 3
Name:
Phone:
Years Known:
List any additional information you would like us to consider.

I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from the employer's service, whenever it is discovered.
I give the employer the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information.
The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state or federal law.
This application is current for only 60 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application.
I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.
Final employment offer is contingent upon passing physical and drug and alcohol screen. I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.
Name (required):
Email (required):
An Equal Opportunity Employer

[ Home ] [ About ] [ Rates ] [ Performance ] [ Contact ] [ Employment ] [ Privacy ]