Employment Application (1)

Please answer all questions on this application, put N/A in the text box of questions that are not applicable.

Name(Required)
Present Address(Required)
Previous Address(Required)
MM slash DD slash YYYY
Type of employment(Required)

General

If Hired, can you provide proof that you are legally entitled to work in the U.S.?(Required)
Have you ever worked for Taylor-Made Pumping before?(Required)
Do you have friends or relatives that work at Taylor Made Pumping?(Required)
Do you have commitments to any other employer?(Required)
Do you have any limitations which would prevent you from performing specific kinds of work?(Required)
Have you ever been convicted of a felony?(Required)
Conviction of a crime is not an automatic bar to employment - All circumstances may be considered.
Have you ever been convicted of a misdemeanor?(Required)
Conviction of a crime is not an automatic bar to employment - All circumstances may be considered.
Have you ever been bonded?(Required)
Have you ever been rejected by a bonding company?(Required)
Have you ever been discharged from any positions?(Required)

Employment Record

The U.S. Department of Transportation requires that driver applicants show all employment for the past three years. Effective July 1987 they must also show commercial driver employment for the seven years immediately preceding this three year period.
Employment History (dates must be consecutive years)(Required)
*If you need more spaces, please click the "plus" button*
Dates of Employment
Name and Addres of Employer
Rate of Pay (Start to Finish)
Supervisor Name and Title
Reason for leaving
 
Have you ever served in the U.S. armed forced?(Required)

Education

Please select your highest level of eduction:(Required)
Personal References(Required)
Please list persons you know well - Not previous employers or relatives. If you need more spaces, please click the "plus" button.
Name
Occupation
Address
Phone Number
Number of years known
 

Driver Experience & Qualifications

The U.S Department of Transportation requires that applicants state their date of birth.
MM slash DD slash YYYY

Physical History

The U.S Department of Transportation requires that all applicants pass certain physical tests before they are hired to drive a motor carrier.
Have you ever been granted a waiver under section 391.49 Federal Motor Carrier Safety Regulations pertaining to the loss of foot, leg, hand or arm?(Required)
Licenses(Required)
Drivers Licenses held in the past 3 years must be shown If you need more spaces, please click the "plus" button.
State
License No.
Type
Expiration Date
 
Have you ever been denied a license, permit or privilege to operate a motor vehicle?(Required)
Has any license, permit or privilege ever been suspended or revoked?(Required)
Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?(Required)
Driver Experience(Required)
If you need more spaces, please click the "plus" button.
Class of Equipment
Type of Equipment
Dates
Approximate Total Miles
 
Accident Review for past 3 years(Required)
If you need more spaces, please click the "plus" button.
Dates
Nature of accident
Fatalities
Injuries
 
Traffic Convictions and Forfeitures for the past 3 years other than parking violations.(Required)
If you need more spaces, please click the "plus" button.
Location
Date
Charge
Penalty
 

Maintenance Experience & Qualifications

Indicate training and experience in the following:(Required)
-(Required)
-(Required)
Indicate training and experience in the following:
-
-

Clerical Experience & Qualifications

Indicate training and experience in the following:
-
-
-
Applicants Statement(Required)
Please make sure to add your signature only if you have read the applicant statement.
Max. file size: 300 MB.
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