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Employment Application Position Applying For: OTR /Regional driversCity Drivers
Contact Info First Name (required)
Middle Name
Last Name (required)
Have you ever worked or attended school under any other name? yesno
If yes list name(s)
Cell Phone Number:
Secondary Phone Number:
Your Email (required)
Date of Birth:
Emergency Contact (name and phone number)
Current Residence
Current Address:
Current City:
Current State:
Years in Residence:
Previous Residence
Previous Address:
Previous City:
Previous State:
Job Info
Date Available
Desired Rate of Pay
Have you ever applied for a job with us before? yesno
How were you referred to us?
List any friends or relatives working for us:
Are you a citizen of the United States? yesno
If no, are you authorized to work in the U.S.? yesno
Are you prevented from being lawfully employed in this country because of a visa or immigration status? yesno
Have you ever been convicted of a felony? yesno
If yes, please explain:
Education
High School:
Dates Attended:
Did you graduate? yesno
College
Degree
Trade School
Military Experience
Have you served in any of the US military branches? yesno
Which branch?
Date of Entry
Date of Separation
Rank at Separation
Medical History
Are you taking any medications now? yesno
If Yes, please describe what medication and the reason
Do you have a current D.O.T. physical certificate? yesno
Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you have applied for employment but did not obtain safety sensitive transportation work covered by D.O.T. agency drug and alcohol rules during the past 2 years? yesno
If YES please explain
Employment History FIRST MOST RECENT Name of Employer or Unemployment Supervisor Full Address Phone number Position Dates of employment (from and to) Hours per week Salary Reason for leaving SECOND MOST RECENT Name of Employer or Unemployment Supervisor Full Address Phone number Position Dates of employment (from and to) Hours per week Salary Reason for leaving THIRD MOST RECENT Name of Employer or Unemployment Supervisor Full Address Phone number Position Dates of employment (from and to) Hours per week Salary Reason for leaving Personal References Name Phone Name Phone Name Phone DRIVER LICENSE HISTORY State Issued Driver License Number Type Expiration Date Have you ever been denied a license or permit to operate a vehicle? yesno If yes please explain Has Any License, Permit or Privilege Ever Been Suspended or Revoked? yesno If yes please explain Have You Ever Been Convicted of a Felony? yesno If yes please explain Please list all conviction(s) and forfeiture(s) for the past five (5) years; traffic; truck/car (do not include parking violations), misdemeanor(s) & felonies unless annulled, expunged or sealed by a court. If none, write “none”. A conviction record will not necessarily be a bar to employment. Factors such as age, time of the offense, the seriousness, nature of the violation, and rehabilitation will be taken into account.” Conviction Date City & State Penalty EXPERIENCE - EQUIPMENT Type Of Equipment Dates Type Of Equipment Dates Accident Record – List all car and truck involvements in the past five (5) years Type: Date: Type: Date: Type: Date: Employment Agreement: I certify that the information on this application and its supporting documents was completed by me and is accurate and complete to the best of my knowledge. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I certify that the above conviction data is true and complete list of all violations (other than parking) that I have been convicted or forfeited bond or collateral during the past five years. I authorize GSA International, Ltd. to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers to make full response concerning my previous employment and/or pertinent information they may have, personal or otherwise, to any inquiries in connection with this application for employment. I release all such parties from all liability for any damage that may result from giving or receiving any such information. I waive all notices regarding release of such information, including but not limited to Bullard-Plawecki Right-To- Know-Act. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that staff employees of GSA International, Ltd. serve at-will, and the employment relationship may be terminated at any time by either party, for any, or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States and to comply with company and departmental regulations. I understand that if employed on a temporary basis, I would be paid for hours worked only, and would be ineligible for benefits including paid time off. If employed on a regular, benefits- eligible basis. I understand that any benefits I receive may be subject to change or discontinuation at any time without prior notice. I understand that the first 90 DAYS of employment represent a probationary period, during which I may be terminated without right of appeal. I hereby state that if I have been offered, and accept employment with GSA International Ltd. I will be assigned to American Logistics Group as an employee. If you are filling out this application online GSA International, Ltd. requires that you certify your application by submitting an electronic signature. To certify your application type your full name in the box below. I have read the terms and conditions. yesno First and Last Name: Submit your resume here:
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