Do you have the right to work in the United States: Yes No

Birth Date (mm/dd/yy) Can you provide proof of age? Yes No

Have you worked for this company before? Yes No

Where?

Dates:  From: To: Rate of pay:

Position:

Reason for leaving:

Are you now employed: Yes No

If not, how long since your last employment?

Who referred you?

Rate of pay expected:

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If yes, please explain:

 

 

Traffic convictions and forfeitures for the past 3 years (other than parking violations):

Education:

Driver Licenses

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No
B. Has any license, permit or privilege ever been suspended or revoked? Yes No

C. Have you ever been convicted of a felony or DUI?  Yes No

If the answer is YES to any of the above questions please give details:

Driving Experience (If none, type  none)

List the states you have operated in for the last five years:

Show special courses or training that will help you as a driver:

Do you hold any  safe driving awards?  If so,  from whom?

 

Please click here to review the Van Driver Job Description which will open in a new window.  After reviewing, close the window it opened in, and please choose one of the following statements:

 

I may perform all functions without any restrictions.

I am unable to perform essential functions.

 

The prospective employee is required by Sec. 40.25(j) to respond to the following questions:

 

1) Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past three years?   Yes No

 

2) If you answered yes, can you provide/obtain proof that you've successfully completed the DOT return-to-duty requirements?   Yes No

 

Answer the following questions as accurately as possible.  By completing this section of your application, we at Woodfield will be able to access and process your application quickly and accurately.

 

Why have you selected Woodfield as possible employment?

 

Can you correctly recap your hours of service?

 

Are you familiar with Qual-Com?

 

Is there any reason why you could not travel outside the United States?

 

Do you expect Woodfield to furnish you with a truck to be used for personal use?  Why?

 

List some things you look for in doing your inspections of equipment:

 

PLEASE READ THE FOLLOWING STATEMENT BEFORE CLICKING SUBMIT APPLICATION:

I authorize you to make such investigations and inquiries of my personal, employment, financial, or medical history and other related matters as may be necessary in arriving at an employment decision.  (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.)  I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.  

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.  I understand, also, that I am required to abide by all rules and regulations of the Company.

I understand that my qualification can be terminated, with or without cause, at any time at the discretion of either the company or myself.

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e).  I understand that I have the right to:

• Review information provided by previous employers;

• Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer, and;

• Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

 

Please type your name and today's date in the box below to indicate that you have read the above statement before submitting your application.  When complete, click submit application below.

 

Name:      Today's Date: