Careers - Peet Frate Line, Inc.

Date of Application

Position(s) Applied For *

First Name *

Last Name *

Street

City

State

Zipcode

Phone Number *

Hazmat Certified

Yes

No

Any previous addresses in the past 3 years?

Yes

No

LIST YOUR PREVIOUS ADDRESSES FOR THE PAST 3 YEARS

Previous Addresses

Street

City

State

Zipcode

Phone

How Long?

Add Remove

Are you Employed Now?

Yes

No

If Not, How long since leaving last employment? *

Do you have the legal right to work in the United States?

Yes

No

Rate of Expected Pay

Have you been in any accidents in the past 3 years?

Yes

No

Section

Accident Record for the past 3 years or more

Date

Nature of Accident (Head-On, Rear-End, Upset, etc.)

Fatalities

Yes

No

Injuries

Yes

No

Add Remove

Have you received any traffic violations in the past 3 years?

Yes

No

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE

Traffic Convictions and Forfeitures for the past 3 years (Other than parking violations)

Date

Location

Charge

Penalty

Add Remove

Education

Last School Attended

Have you ever been denied a license, permit or privilege to operate a motor vehicle? *

Type of Equipment

(Van, Tank, Flat, Etc.)

From Date

To Date

Approximate Number of Miles

(Total)

Add Remove

List states operated in for last five years.

Special courses or training that will help you as a driver

TO BE READ AND SIGNED BY APPLICANT

This certifies that this application was completed by me, and all entries on it and information in it are true and complete to the best of my knowledge. 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. APPLICANT MUST SIGN NAME BELOW

Today's Date

Applicant's Signature

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code. Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent.)

Employer Name

Address

City

State

Zipcode

Contact Person

Phone Number

From Date

To Date

Position Held

Salary/Wage

Reason for Leaving

reCAPTCHA

Add Additional Employment History Remove

Application For Employment

LIST YOUR PREVIOUS ADDRESSES FOR THE PAST 3 YEARS

Section

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE

DRIVING EXPERIENCE

Straight Truck

Tractor and Semi-Trailer

Tractor - Two Trailers

Motorcoach - School Bus

Other

TO BE READ AND SIGNED BY APPLICANT

EMPLOYMENT HISTORY