An Equal Opportunity Affirmative Action Employer

Please Print Application for Employment

We are an equal opportunity employer. Applicants are considered for positions without regard to race, religion, sex, national origin, age, disability, or any other category protected by applicable federal, state, or local laws.

Applicant Information

Today’s Date
Last Name / First / M.I.
Street Address / Apartment/Unit #
City / State / ZIP
Home Phone / Cell Phone
Social Security No. / - - / Date of Birth
Position Applied for / Dump Truck Driver Dump Trailer Driver Mechanic
Full Time Part-Time (Specify Hours) ______
Date you can start / Expected rate of pay
Do you have the legal right to work in the United States? / YES / NO
Have you ever been convicted of a felony? / YES / NO
Have you ever been bonded? / YES / NO / Name of Bonding Company
Is there any reason you might be unable to perform the functions of the job for which you have applied? / YES / NO / If no, please list accommodation needed:
Are you currently employed? / YES / NO
Have you ever applied or worked for R.S. Thomas Hauling, Inc. before? / YES / NO / Dates
Who referred you?
Use this space if you need to provide additional information for the questions above.

Education

High School / Address
From / To / Did you graduate? / YES / NO
College / Address
From / To / Did you graduate? / YES / NO / Degree
Bus./Tech./Trade / Address
From / To / Did you graduate? / YES / NO / Degree

eXPERIENCE / skills

**Please complete this section based on the position you are applying
How long have you been driving Dump Trucks? ______
How long have you been driving Dump Trailers? ______/ Class Type
A
B
DOT Physical Exam Expiration Date:
This section is only for person
Applying for a Mechanic Position: / Fleet Mechanic
____ Years experience
State Inspection License
Welding & Fabrication
Air brake repair
Routine preventative maintenance
Hydraulic and engine repairs
Chassis repair
Fuel Injection Systems repairs
Transmission repairs
Electrical System repairs

Previous Employment

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.
Company / Phone / ( )
Address / Supervisor
Job Title / Salary / $
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO
Company / Phone / ( )
Address / Supervisor
Job Title / Salary / $
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO
Company / Phone / ( )
Address / Supervisor
Job Title / Salary / $
Responsibilities
From / To / Reason for Leaving
My we contact your previous supervisor for a reference? / YES / NO
REFERENCES
Full Name / Relationship
Company/Address / Phone
( )
Full Name / Relationship
Company/Address / Phone
( )
Full Name / Relationship
Company/Address / Phone
( )

DRUG & ALCOHOL TESTING/AUTHORIZATION

I understand that I will be required to participate in urine samples for substance abuse and breathalyzer testing for alcohol. I consent to such testing and understand that in addition to testing as a part of the pre-employment screening process, I will be subject to future random testing, which may include job-related accidents, reasonable suspicion etc. I understand that in the event that I refusea test or violate the Company’s drug and alcohol policy, or test positive for substance abuse, my application for employment will be disqualified from further consideration and/or my employment will be terminated without notice.
Signature of Applicant ______Date ______
AUTHORIZATION, DISCLAIMER AND SIGNATURE: It is agreed and understood that any misrepresentation given on this document shall be considered on act of dishonesty. It is agreed and understood that the motor carrier or their agents may investigate my background to ascertain any and all information of concern to commercial driving record, whether same of record or not, and I release the employers and persons named herein from all liability for any damages on account of their furnishing such information. It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 9-508, I have been told that this investigation may include an investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.
Driver’s License Number ______State______
Signature of Applicant ______Date ______