Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 8Job Application Data Protection & Liability Statement (Florida)By submitting this Job Application Form, you acknowledge that the personal information you provide will be collected, processed, and maintained in accordance with applicable federal and Florida laws, including the Florida Information Protection Act (Section 501.171, Florida Statutes), and other relevant data protection regulations. The information submitted will be used solely for employment consideration and related administrative purposes and will not be publicly published by the Company. The Company implements reasonable administrative, technical, and physical safeguards to protect submitted information; however, the Company shall not be liable for unauthorized access, disclosure, alteration, or publication of information caused by events or parties beyond its reasonable control, including third-party cyber incidents or unlawful acts. Information will be retained only for as long as necessary to fulfill legitimate business and legal obligations.Personal/Contact Info:Name *FirstLastPhone *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDate of Birth: *Email *Position Applying for: *--- Select Choice ---Dump Truck DriverLowboy DriverFuel Truck DriverRate of Pay Expected: *What is your highest level of education completed? *--- Select Choice ---High SchoolCollegeGrad SchoolOtherName of School: *Address of School: *List any job-related skills or qualifications that support your application:Are you a veteran of the US Military Service? *--- Select Choice ---YesNoIf yes, what was your date of discharge?What is your ethnicty? *--- Select Choice ---White (Not of Hispanic Origin)Black (Not of Hispanic Origin)HispanicAmerican Indian or Alaskan NativeOtherDisclaimer: This question is required for Equal Opportunity Reporting, and has no bearing on your chances of hire.Gender: *--- Select Choice ---MaleFemaleNextEmployment Experience:List your 4 most recent jobs, starting with the most recent, Including any periods of self-employment or military service:Job #1Job #1 Name: *Job #1 Address: *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeJob #1 Phone: *Job #1 Start Date: *Job #1 End Date: *Job #1 Position Held: *Job #1 Work Performed: *Job #1 Starting Pay/Salary: *Job #1 Ending Pay/Salary: *Job #1 Immediate Supervisor: *Job #1 Reason for Leaving: *Were you subject to the FMCSRs while employed? *--- Select Choice ---YesNoWas your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40? *--- Select Choice ---YesNoJob #2Job #2 Name: *Job #2 Address: *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeJob #2 Phone: *Job #2 Start Date: *Job #2 End Date: *Job #2 Position Held: *Job #2 Work Performed: *Job #2 Starting Pay: *Job #2 Ending Pay: *Job #2 Immediate Supervisor: *Job #2 Reason for Leaving: *Were you subject to the FMCSRs while employed? *--- Select Choice ---YesNoWas your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40? *--- Select Choice ---YesNoJob #3Job #3 Name: *Job #3 Address: *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeJob #3 Phone: *Job #3 Start Date: *Job #3 End Date: *Job #3 Position Held: *Job #3 Work Performed: *Job #3 Starting Pay: *Job #3 Ending Pay: *Job #3 Immediate Supervisor: *Job #3 Reason for Leaving: *Were you subject to the FMCSRs while employed? *--- Select Choice ---YesNoWas your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40? *--- Select Choice ---YesNoJob #4Job #4 Name:Job #4 Address:Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeJob #4 Phone:Job #4 Start Date:Job #4 End Date:Job #4 Position Held:Job #4 Work Performed:Job #4 Starting Pay:Job #4 Ending Pay:Job #4 Immediate Supervisor:Job #4 Reason for Leaving:Were you subject to the FMCSRs while employed?--- Select Choice ---YesNoWas your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40? (copy)--- Select Choice ---YesNoNextAccident RecordPlease add the details of any accidents experienced in the past 5 years in the space provided below. If you have had none, you may skip this page.-Last Accident-Date of Accident:Nature of Accident:Injuries:Fatalities:Hazardous Material Spill?YesNo-Next Previous- Date of Accident:Nature of Accident:Injuries:Fatalities:Hazardous Material Spill?YesNo-Next Previous-Date of Accident:Nature of Accident:Injuries:Fatalities:Hazardous Material Spill?YesNoNextTraffic ConvictionsPlease list any traffic convictions or forfeitures you have incurred in the past 3 years, not including parking violations. If you have had none, you may skip this page.-Last Conviction-Location:Date:Charge:Penalty:-Next Previous-Location:Date:Charge:Penalty:-Next Previous-Location:Date:Charge:Penalty:NextLicenses & EndorsementsLicense #1Issuing State: *License No.: *Class: *--- Select Choice ---CDL ACDL BEndorsement(s): *Expiration Date: *License #2Issuing State:License No.:Class:CDL ACDL BEndorsement(s):Expiration Date:License #3Issuing State:License No.:Class:CDL ACDL BEndorsement(s):Expiration Date:NextMisc. Info:List states operated in for the last five years: *Can you perform, with or without reasonable accommodation, the essential functions of the job [as described in the job description]? *--- Select Choice ---YesNoShow special courses or training that will help you as a driver:Which safe driving awards do you hold, and from whom?Show any trucking, transportation, or other experience that may help in your work for this company:Have you ever been dismissed or forced to resign from any employment? *--- Select Choice ---YesNoIf yes, please explain:Do you have transportation to work? *--- Select Choice ---YesNoWill you work overtime if asked? *--- Select Choice ---YesNoAre there any hours, shifts or days you will not work? *--- Select Choice ---YesNoIf yes, please elaborate:Do you have any friends or relatives who work here? *--- Select Choice ---YesNoIf yes, please enter their name(s) and relation to you below:Name/Relationship:Enter multiple individuals if necessary.Are you currently employed? *--- Select Choice ---YesNoAre you on a layoff? *--- Select Choice ---YesNoAre you subject to recall? *--- Select Choice ---YesNoMay we contact your present Employer? *--- Select Choice ---YesNoMay we contact your previous Employers? *--- Select Choice ---YesNoIf no, please explain reasoning for not contacting previous employers:NextCharacter References:Please list three persons not related to you, whom you have known at least one year.-Person #1- License of Issuing Name: *FirstLastPhone: *Occupation: *-Person #2-Name: *FirstLastPhone: *Occupation: *-Person #3-Name: *FirstLastPhone: *Occupation: *NextApplicant's Statement:I certify that the answers given herein are true and complete to the best of my knowledge. I authorize the investigation of all matters contained in this application and hereby give the Employer permission to contact schools, previous employers, references, and others and hereby release the Employer from any liability as a result of such contact. I understand that misrepresentation or omissions of facts called for in this application will be cause for dismissal at any time without any previous notice. Applicants accepted for employment should clearly understand that while we make every effort to provide steady, continuous work, we have no employment contracts, and we cannot guarantee the permanence of any position. Job tenure can be affected by many factors including business economic conditions, changes in laws or employee policies, conformity to our work rules, job performance, etc. And of course an employee may elect to leave on their own accord to seek other jobs. I understand that my employment with the Employer is for no specific term and may be terminated by me or the Employer with or without notice or cause at any time. I further understand that no oral promise, employer policy, custom, business practice or other procedure (Including the Employer's Personnel Handbook or any personnel manuals) constitutes an employment contract or modification or the at-will employment relationship between me and the Employer. The content of any employee handbook or personnel manuals, as well as other employer policies and practices, are subject to change or modification by the Employer, solely at its discretion, without notice. I also understand that no supervisor or other official of the Employer (except its Chief Executive Officer, in writing) has the authority to enter into any agreement with me or to make any agreement contrary to the foregoing. We conduct our business with the highest possible degree of safety and efficiency. Because of this, the Employer may require applicants for employment to undergo blood and/or urinalysis screening for drug or alcohol use as part of our pre-placement physical examination. In addition, all employees of the Employer are subject to blood tests or urinalysis screening for drug or alcohol use. This application will remain for ninety (90) days. Any applicant wishing to be considered for employment beyond ninety (90) days should reapply. I agree in advance if there is a workmen's compensation or health claim, I the undersigned agree to an illegal substance and alcohol testing and understand that if I test positive my benefits will be terminated. Signature * Clear Signature Section DividerSubmit