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Applying for Position in: |
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*Job
applying for: |
Company
Driver
Office
Owner
Operator
Warehouse |
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*Name: |
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*Address: |
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*City: |
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*Province/State: |
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*Postal
Code/ZIP: |
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*Social
Security #: |
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*Date
of Birth: |
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*Phone
Number: |
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*Alt Phone
or Pager #: |
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E-Mail
Address: |
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*Date Available
For Orientation: |
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*Driver's
License #: |
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*Issuing
State: |
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*Expiry
Date: |
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*States Operated In: |
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*CDL
Y/N?: |
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*HazMat
Endorsement Y/N?: |
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*How many
tickets in the last 5 years?: |
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*How many
accidents in the last 5 years?: |
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*Have you been
arrested for DUI Y/N?: |
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If Yes,
when?: |
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*Have you tested
positive for a controlled substance in the last 2 years Y/N?: |
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*Have you had your license
suspended or revoked in the last 5 years Y/N?: |
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If Yes,
when?: |
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*Have you ever been convicted of a misdemeanor
or a felony Y/N?: |
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If Yes, please explain: |
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*Please list your last
36 months of employment: |
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Date From: |
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To: |
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Employer: |
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Position: |
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Phone#: |
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City: |
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State: |
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Zip: |
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Type of Trailer(s): |
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Reason for Leaving: |
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Continued... |
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Date From: |
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To: |
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Employer: |
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Position: |
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Phone#: |
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City: |
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State: |
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Zip: |
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Type of Trailer(s): |
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Reason for Leaving: |
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Continued... |
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Date From: |
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To: |
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Employer: |
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Position: |
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Phone#: |
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City: |
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State: |
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Zip: |
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Type of Trailer(s): |
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Reason for Leaving: |
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Please use this for additional employment experience: |
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I certify that I personally completed this application for the purpose of employment and that all the information herein is true and correct. I
authorize Rosedale Transport, Inc. to do a complete background investigation in accordance with federal and state law. I authorize release of
any information, including all information related to my alcohol and controlled substances testing and training records, as required by Section
382.401 (B) of the Federal Motor Carrier Safety Regulations, by any former employers and hold them harmless of any liability from release
of said information. I also consent to the procurement and use of any consumer reports, including reports from DAC Services, Inc., deemed
necessary by Rosedale Transport, Inc., or its subsidiaries in consideration of my employment. |
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*Please enter your name as proof of release: |
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Comments: |
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