Employment Application

Applicant Information
In compliance with Federal and State Equal Employment Opportunity (EEO) laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or non-job related disability.
Full Name:
SSN
###-##-####
Date of Birth:
mm/dd/yyyy
Phone:
###-###-####
 Cellular Phone:
###-###-####
Email Address
List your addresses of residency for the past 3 years:
Address:
City, State & Zip:
Months:
Previous Address:
City, State & Zip:
Months:
Previous Address:
City, State & Zip: 
Months: 
Do you have a DWI or DUI on your Driver record?
Have you ever been convicted of a crime?
If so, give date of DUI:
mm/dd/yyyy
If so, explain the crime:
(max length 145)
Have you ever tested positive on a DOT drug or alcohol test? Are you employed now?
If so, give date of drug test
mm/dd/yyyy
If so, may we inquire of present employer?

Emergency Contact Information
Name:
Relationship:
Phone:
Workplace:
Who referred you to Pritchett Trucking?

Employment History
Please complete with your previous 10 years work history, starting with your most recent employer.  Cover all time for the last 10 years.  If you were unemployed for more than 30 days, indicate each of those time periods in one of the employer boxes.
Employer 1
Name:
From:
Year:
Address:
To:
Year:
City, State & Zip:
Position Held:
Contact Person:
Salary/Wage:
Phone Number:
###-###-####
Reason For Leaving:
Were you subject to the FMCSRs while employed:
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?
Employer 2
Name:
From:
Year:
Address:
To:
Year:
City, State & Zip:
Position Held:
Contact Person:
Salary/Wage:
Phone Number:
###-###-####
Reason For Leaving:
Were you subject to the FMCSRs while employed:
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?
Employer 3
Name:
From:
Year:
Address:
To:
Year:
City, State & Zip:
Position Held:
Contact Person:
Salary/Wage:
Phone Number:
###-###-####
Reason For Leaving:
Were you subject to the FMCSRs while employed:
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?
Employer 4
Name:
From:
Year:
Address:
To:
Year:
City, State & Zip:
Position Held:
Contact Person:
Salary/Wage:
Phone Number:
###-###-####
Reason For Leaving:
Were you subject to the FMCSRs while employed:
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?
Employer 5
Name:
From:
Year:
Address:
To:
Year:
City, State & Zip:
Position Held:
Contact Person:
Salary/Wage:
Phone Number:
###-###-####
Reason For Leaving:
Were you subject to the FMCSRs while employed:
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?
Employer 6
Name:
From:
Year:
Address:
To:
Year:
City, State & Zip:
Position Held:
Contact Person:
Salary/Wage:
Phone Number:
###-###-####
Reason For Leaving:
Were you subject to the FMCSRs while employed:
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

Driver's License Information
List the valid operating license in your possession:
CDL Class: State: Number: Expiration Date: mm/dd/yyyy
Have you ever lost your driving privileges? Haz/Mat Endorsement:
If so, explain why you lost your driving privileges:
(max length is 134)

Driving Violations
List below all moving violations you have received in the past 3 years:
Date mm/dd/yyyy Offense Location Type of Vehicle

Traffic Accidents
Date mm/dd/yyyy Nature of Accident Fatalities Personal Injury

Experience
Explain experience you have driving.  If you have operated motor vehicle equipment, explain the types and name of states driven in.
 (max length is 185)

Comments
Please list any comments or information you think we need for considering your application:
 (max length is 250)

Acknowledgment
This certifies this online 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 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 may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Pritchett Trucking.
Date: mm/dd/yyyy Your Initials:

Pritchett Trucking, Inc., providing you with truckload transportation is just the beginning. Our goal is to make you a customer for life. That takes more than creative excellence, technical prowess in finding low, low pricing. It requires relentless attention to every detail. To do the big things well, we know we must do the small things brilliantly. Pritchett Trucking, Inc. meets the challenge. The excellence we put into our search for the best transportation solutions for our clients is exceeded only by the quality of service we provide.

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