Application | Billman Trucking

Position(s) Applied for*
Name*
First Middle Last
Current Address
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
How Long?
Previous Address
Address 1
Street Address Address Line 2 City State ZIP Code
How Long?
Address 2
Street Address Address Line 2 City State ZIP Code
How Long?
Address 3
Street Address Address Line 2 City State ZIP Code
How Long?
Do you have the legal right to work in the United States?*
Date of Birth*
Can you provide proof of age?*
Have you worked for this company before?*
Where?
From
To
Rate of Pay
Position
Reason for leaving?
Are you now employed?*
If not, how long since leaving last employment?
Who referred you?
Rate of pay expected*
have you ever been bonded?*
Name of bonding company
Have you ever been convicted of a felony?*
If yes, please explain fully. Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.
Is there any reason you might be unable to perform the functions of the job for which you have applied [as described in the job description]?*
If yes, explain if you wish.

Employment History
Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
From*
To*
Position Held*
Salary/Wage*
Reason for Leaving*
Did you drive a vehicle requiring a cdl?*
Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
From
To
Position Held
Salary/Wage
Reason for Leaving
Did you drive a vehicle requiring a cdl?
Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
From
To
Position Held
Salary/Wage
Reason for Leaving
Did you drive a vehicle requiring a cdl?
Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
From
To
Position Held
Salary/Wage
Reason for Leaving
Did you drive a vehicle requiring a cdl?

Accident Record
Last Accident
Nature of Accident
Fatalities
injuries
Next Previous
Nature of Accident
Fatalities
injuries
Next Previous
Nature of Accident
Fatalities
injuries
Education
Highest grade completed*
Last school attended*
Address*
City State / Province / Region
Experience and Qualifications - Driver
State
License No.
Type
Expiration Date
State
License No.
Type
Expiration Date
State
License No.
Type
Expiration Date
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Has any license, permit or privilege ever been suspended or revoked?
If you answer "Yes" to either of the last two questions please explain
Driving Experience - If none, write "None"
Straight Truck
Type of equipment (Van,Tank,Flat,ETC.)
From
To
Approx Number of total miles
Tractor and Semi-Trailer
Type of equipment (Van,Tank,Flat,ETC.)
From
To
Approx Number of total miles
Tractor - Two Trailers
Type of equipment (Van,Tank,Flat,ETC.)
From
To
Approx Number of total miles
Motorcoach - School Bus
Type of equipment (Van,Tank,Flat,ETC.)
From
To
Approx Number of total miles
Other
Type of equipment (Van,Tank,Flat,ETC.)
From
To
Approx Number of total miles
List states operated in for last five years
Show special courses or training that will help you as a driver
Which safe driving awards do you hold and from whom?

Experience and Qualifications - Other
Show any trucking, transportation or other experience that may help in your work for this company
List courses and training other than shown elsewhere in this application
List special equipment or technical materials you can work with (Other than those already shown)
To Be Read and Signed By Applicant
This certifies that this application was completed by me, and that 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, inquires reagarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, scholls, 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 emloyment, 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 agree
Date*
Name*
First Last
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Current Address