Job Application Form

In compliance with Federal and State equal employment opportunity laws, we consider qualified applicants for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job-related disability, or any other protected group status.

TO BE READ AND SIGNED BY APPLICANT

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, the school’s 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 also understand that I am required to abide by all Company rules and regulations.

Date:

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Signature:

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Are you applying for a driver position?

Yes

DRIVER APPLICANT ONLY

I understand that the 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 rights 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.

Date:

This field is required.

Signature:

This field is required.

The U.S. Department of Transportation requires that the driver applicants state their date of birth (391.21(b)(2)).

Date of Birth:

This field is required.

Applicant Full Name:

This field is required.

Current Address:

Address Line 1:

This field is required.

Address Line 2:

This field is required.

City:

This field is required.

Zip Code:

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Country:

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Have you lived at this address for 3 years or more?

Yes

This field is required.

Previous Address #1

Address Line 1:

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Address Line 2:

This field is required.

City:

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Zip Code:

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From:

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To:

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Previous Address #1

Address Line 1:

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Address Line 2:

This field is required.

City:

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Zip Code:

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From:

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To:

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Phone:

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Email:

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What position are you applying for?

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Expected Pay:

Employment Type:

Full Time

Part Time

Temporary

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Were you referred by someone?

Yes

Who referred you?

This field is required.

Have you worked for KBS, INC. before?

Yes

What name, if different from above, did you work under?

This field is required.

Where:

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Position:

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Pay Rate:

From Which Date:

To Which Date:

Reason for leaving:

Do any of your relatives work for KBS, INC.?

Yes

Name of Relative: #1

First Name:

This field is required.

Last Name:

This field is required.

Are you currently employed?

Yes

This field is required.

How long has it been since your last employment?

This field is required.

EDUCATION

Last School Attended:

School Name:

This field is required.

City:

This field is required.

State:

This field is required.

GENERAL

Have you ever been convicted of a felony?

Yes

Provide a detailed explanation:

A conviction is not an automatic bar to employment. All circumstances will be considered.

DRIVERS EXPERIENCE & QUALIFICATION

Are you applying for a driver position?

Yes

Drivers Licenses

List all driver's licenses held during the past 3 years.

Driver's License #1

License Number:

This field is required.

Class:

This field is required.

Endorsement(s):

This field is required.

Expiration Date:

Driver's License #1

License Number:

This field is required.

Class:

This field is required.

Endorsement(s):

This field is required.

Expiration Date:

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

Yes

Please provide details explaining why you were denied:

Has any license, permit, or privilege ever been suspended or revoked?

Yes

Please provide details explaining why you were suspended or revoked:

Driving Experience

Which classes of equipment do you have driving experience with?

Select all that apply.

Straight Truck

Tractor & Semi-Trailer

Tractor — Two Trailers

Tractor — Three Trailers

Motocoach/School Bus

Other

EQUIPMENT TYPE #1

FROM:

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TO:

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Approx Total Miles:

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List other states operated in during the last five years:

This field is required.

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

This field is required.

Do you hold any safe driving awards?

Yes

Safe Driving Award #1

Award Name:

This field is required.

Issued by:

This field is required.

ACCIDENT RECORD

Have you had an accident in the past 3 years?

Yes

Accident #1

Please list most recent accident(s) first.

Date of Accident:

Cause of Accident:

This field is required.

Fatalities:

This field is required.

Injuries:

This field is required.

Hazardous Material Spill:

This field is required.

TRAFFIC CONVICTIONS AND FORFEITURES

Have you had any traffic convictions or forfeitures in the past three years?

Yes

Traffic Conviction / Forfeiture #1

Location:

This field is required.

Date:

Charge:

This field is required.

Penalty:

This field is required.

Are you applying to work in the shop or as a mechanic?

Yes

Do you have maintenance experience or qualifications?

Yes

Have you completed any courses or training in maintenance work?

Yes

Maintenance Course/Training #1

Course or Training Name:

This field is required.

Job Functions & Shop Equipment

If you have training or experience in more than one area below, click the + button to add another entry. Please provide the requested details for each job function or type of shop equipment.

Job Function #1

Years of Experience:

This field is required.

Shop Equipment #1

Years of Experience:

This field is required.

Do you have any ASE certifications?

Yes

ASE Certification #1

Certification Name:

This field is required.

Employment History

All driver applicants seeking to drive in interstate commerce must provide employment information for all employers during the preceding 3 years, including the complete mailing address, street number, city, state, and ZIP code.

Applicants seeking to drive a commercial motor vehicle in intrastate or interstate commerce must also provide an additional 7 years of employment history for employers for whom the applicant operated a commercial motor vehicle.

Please list all employers in reverse chronological order, beginning with your most recent employer. Click the + button to add additional employers as needed.

Employer #1

Employer Name:

This field is required.

Address:

This field is required.

City:

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Zip Code:

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From:

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To:

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Position Held:

This field is required.

Salary/Wage:

This field is required.

Contact Person:

This field is required.

Phone Number:

This field is required.

Reason for Leaving:

This field is required.

Employer #1

Employer Name:

This field is required.

Address:

This field is required.

City:

This field is required.

Zip Code:

This field is required.

From:

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To:

This field is required.

Position Held:

This field is required.

Salary/Wage:

This field is required.

Contact Person:

This field is required.

Phone Number:

This field is required.

Reason for Leaving:

This field is required.

Regulatory Information

Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle:

1. Weighs or has a GVWR of 10,001 pounds or more;

2. Is designed or used to transport more than 8 passengers (including the driver); or

3. Is of any size and is used to transport hazardous materials in a quantity requiring placarding.

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