Imler's Employment - Truck Driver

 

Imler's Truck Driver's
Application for Employment



In compliance with Federal and State equal employment opportunity 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.



*ALL FIELDS MUST BE COMPLETED
 
* Name:
* Email Address:
* Position Applied For:(Long Haul or Delivery)
* Social Security No.
 
**List your addresses of residency for the past 3 years.**
   

Current Address:

 
* Street
* City:
* State:
* Zip:
* Phone Number
* How Long?
 

Previous Address:

 
* Street
* City:
* State:
* Zip:
* How Long?
 
* Do you have a legal right to work in the United States? Yes
No
     
* Date of Birth
(Required for Commercial Drivers)
* Can you provide proof of age? Yes
No
     
* Have you ever worked for this company before? Yes
No
     
* If so, where? ( if none write NA )
     

Dates

   
* From (date) if not applicable write NA
* To (date) if not applicable write NA
* Rate of Pay if not applicable write NA
* Position if not applicable write NA
     
* Reason for leaving? ( if not applicable write NA )
     
* Are you currently employed? Yes
No
* If not, how long since last employment?
* If not applicable write NA
 
* Who referred you?
* Rate of pay expected:
*Are you able to perform the essential functions for the job of which you have applied, with or without, reasonable accomodations? Yes
No
* If no, please explain: ( if not applicable write NA )
 
**EMPLOYMENT HISTORY**

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 who the applicant operated such vehicle.

   
(NOTE: List employers in reverse order starting with the most recent. List others in "others" box below if necessary.)
 
 
Employer (Start with most recent)   Date (mm/dd/yy)
* Name: From:
* Address: To:
* City, ST ZIP:  
* Position Held: Wage:
* Contact Name: Phone:
* Reason for leaving? ( if not applicable write NA )
 
 
Employer   Date (mm/dd/yy)
* Name: From:
* Address: To:
* City, ST ZIP:  
* Position Held: Wage:
* Contact Name: Phone:
* Reason for leaving? ( if not applicable write NA )
 
 
Employer   Date (mm/dd/yy)
* Name: From:
* Address: To:
* City, ST ZIP:  
* Position Held: Wage:
* Contact Name: Phone:
* Reason for leaving? ( if not applicable write NA )
 
 
Employer   Date (mm/dd/yy)
* Name: From:
* Address: To:
* City, ST ZIP:  
* Position Held: Wage:
* Contact Name: Phone:
* Reason for leaving? ( if not applicable write NA )
 
 
Employer   Date (mm/dd/yy)
* Name: From:
* Address: To:
* City, ST ZIP:  
* Position Held: Wage:
* Contact Name: Phone:
* Reason for leaving? ( if not applicable write NA )
 
* Includes vehicles with a GVWR or 26,001 lbs or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placards.
 
ACCIDENT REPORT FOR PAST 3 YEARS OR MORE
(Write in box below if more space is needed). If none, write NA.
 
Last Accident (If none, write NA)
*Date:  
*Nature: (Head-on, Rear-End, Upset, Etc.)
*Fatalities  
*Injuries  
   
Next Previous (If none, write NA)
*Date:  
*Nature: (Head-on, Rear-End, Upset, Etc.)
*Fatalities  
*Injuries  
   
Next Previous (If none, write NA)
*Date:  
*Nature: (Head-on, Rear-End, Upset, Etc.)
*Fatalities  
*Injuries  
   
Use below box for any additional accidents:
(If none write NA)
 
   
TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS
(Other than parking violations). If none, write NA.
 
Conviction One: (If none, write NA)
*Location:  
*Date:
*Charge:  
*Penalty:  
   
Conviction Two:(If none, write NA)
*Location:  
*Date:
*Charge:  
*Penalty:  
   
Conviction Three:(If none, write NA)
*Location:  
*Date:
*Charge:  
*Penalty:  
   
Use below box for any additional convictions:
(If none write NA)
 
   
DO YOU HAVE A HISTORY OF A MISDEMEANOR CONVICTION? Yes
No
   
DO YOU HAVE A HISTORY OF A FELONY CONVICTION? Yes
No
 
(Note: No applicant will be denied employment solely on the grounds of a misdemeanor or felony conviction.)
If yes to either of the above two questions, please explain below:
If none, write NA
 
**EDUCATION**
 
Do you have either a high school diploma or a G.E.D.? Yes
No
 
*Last School Attended
*City:
 
**EXPERIENCE AND QUALIFICATIONS - DRIVER**
 
Driver Licenses:
*State  
*License No.
*Type  
*Expiration Date:  
   
Other Driver Licenses: (If none, write NA)
*State  
*License No.
*Type  
*Expiration Date:  
   
Other Driver Licenses: (If none, write NA)
*State  
*License No.
*Type  
*Expiration Date:  
   
A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Yes
No
   
B. Has any license, permit, or privilege ever been suspended or revoked? Yes
No
 
If the answer to either A or B is yes, write statement giving details below.(If none, write NA)
 
**DRIVING EXPERIENCE
If none, write NA in each box where not applicable**
 
CLASS OF EQUIPMENT: STRAIGHT TRUCK
*Type of Equipment: (Van, Tank, Flat, Etc)
*Date: From:
*Date: To:
*Approx. No. of Miles: (Total)
 
CLASS OF EQUIPMENT: TRACTOR AND SEMI-TRAILER
*Type of Equipment: (Van, Tank, Flat, Etc)
*Date: From:
*Date: To:
*Approx. No. of Miles: (Total)
 
CLASS OF EQUIPMENT: TRACTOR - TWO TRAILERS
*Type of Equipment: (Van, Tank, Flat, Etc)
*Date: From:
*Date: To:
*Approx. No. of Miles: (Total)
 
CLASS OF EQUIPMENT: MOTORCOACH/SCHOOL BUS
*Type of Equipment: (Van, Tank, Flat, Etc)
*Date: From:
*Date: To:
*Approx. No. of Miles: (Total)
 
CLASS OF EQUIPMENT: OTHER
*Type of Equipment: (Van, Tank, Flat, Etc)
*Date: From:
*Date: To:
*Approx. No. of Miles: (Total)
 
*List states operated in for last five years:
*Show special courses or training that will help you as a driver:
(If none, write NA)
*Which special driving awards do you hold and from whom:
(If none, write NA)
 
**EXPERIENCE AND QUALIFICATIONS - OTHER**
 
*Show any trucking, transportation or other experience that may help in your work for this company. (If none, write NA)
 
*List courses and training not shown elsewhere in this application.
(If none, write NA)
 
*List special equipment or technical materials you can work with (other than those already shown) (If none, write NA)
 
TO BE READ AND DATED 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, 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(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the company.

 
*Applicant Name:  
*Today's Date:  
 
**Additional Information**
 
*Use this box to include any additional information that you think would help us in the decision to offer you employment. (If none, write NA)
 
Clicking this button and submitting this application 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. In the event of employment, 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.
 
A * indicates a field is required
 

 



 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

 

Established in 1903, Imler's Poultry is headquartered in Duncansville, Pennsylvania. The company services both retail and foodservice customers throughout the Eastern United States. Imler's customer base includes many National Accounts and their customers are serviced through Imler's privately owned transportation company.

Imler's Poultry

1887 Route 764 ● Duncansville, PA 16635
P.O. Box 836 ● Duncansville, PA 16635

(814) 943-5563 ● (800) 446-5377

 

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