Ingram Trucking

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DRIVER'S ONLINE APPLICATION FOR EMPLOYMENT

INGRAM TRUCKING
P.O. BOX 249
MORGANTOWN, KY 42261

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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.

Position(s) Applied for:

Name: , ,
Last First M.I.

List your addresses of residency for the past 3 years.

Current Address:
,
Street                                           City                                    State                                           Zip
How Long at Current Address?:                               Phone Number:

Previous Addresses 1:
,
Street                                           City                                    State                                           Zip
How Long at Address:

Previous Addresses 2:
,
Street                                           City                                    State                                           Zip
How Long at Address:

Previous Addresses 3:
,
Street                                           City                                    State                                           Zip
How Long at Address:

Do you have the legal right to work in the United States?

Date of Birth: // Can your provide proof of age?

Have you worked for this company before? Where?

Dates: From: To: Rate of Pay: Position:

Reason for leaving:

Are you now employed? If not, how long since leaving last employment?

Who referred you? Rate of pay expected:

Is there any reason you might be unable to perform the functions of the job for which you have applied [as described in the job description]? If yes, explain below if you wish:

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 whom the applicant operated such vehicle.
(NOTE: List employers in reverse order starting with the most recent.)

*Includes vehicles having a GVWR of 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 placarding.

EMPLOYER	DATE
Name:	From: Mo./Yr.	To: Mo./Yr.
Address:	Position Held:
City: , State: Zip:	Salary/Wage:
Contact Person: Phone:	Reason for Leaving:

EMPLOYER	DATE
Name:	From: Mo./Yr.	To: Mo./Yr.
Address:	Position Held:
City: , State: Zip:	Salary/Wage:
Contact Person: Phone:	Reason for Leaving:
EMPLOYER	DATE
Name:	From: Mo./Yr.	To: Mo./Yr.
Address:	Position Held:
City: , State: Zip:	Salary/Wage:
Contact Person: Phone:	Reason for Leaving:
EMPLOYER	DATE
Name:	From: Mo./Yr.	To: Mo./Yr.
Address:	Position Held:
City: , State: Zip:	Salary/Wage:
Contact Person: Phone:	Reason for Leaving:
EMPLOYER	DATE
Name:	From: Mo./Yr.	To: Mo./Yr.
Address:	Position Held:
City: , State: Zip:	Salary/Wage:
Contact Person: Phone:	Reason for Leaving:
EMPLOYER	DATE
Name:	From: Mo./Yr.	To: Mo./Yr.
Address:	Position Held:
City: , State: Zip:	Salary/Wage:
Contact Person: Phone:	Reason for Leaving:
EMPLOYER	DATE
Name:	From: Mo./Yr.	To: Mo./Yr.
Address:	Position Held:
City: , State: Zip:	Salary/Wage:
Contact Person: Phone:	Reason for Leaving:

If more space is needed use the area marked "Miscellaneous" at the end of this application.

ACCIDENT RECORD FOR PAST 3 YEARS OR MORE. IF NONE, WRITE NONE.( Provide additional information in the area marked "Miscellaneous" at the end of this application form if additional room is needed)

DATES	NATURE OF ACCIDENT (Head-on, rear-end, Upset, etc.)	FATALITIES	INJURIES
Last Accident:
Next Previous:
Next Previous:

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE. (Use the "Miscellaneous" area at the end of the application form if more area is needed)

LOCATION	DATE	CHARGE	PENALTY

EDUCATION

SELECT HIGHEST GRADE COMPLETED:
LAST SCHOOL ATTENDED: CITY:

EXPERIENCE AND QUALIFICATIONS - DRIVER

DRIVERS LICENSES	STATE	LICENSE NO.	TYPE	EXPIRATION DATE

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?
B. Has any license, permit or privilege ever been suspended or revoked?
If the answer to A or B is Yes give details below:

DRIVING EXPERIENCE (If none, write none.)

CLASS OF EQUIPMENT	TYPE OF EQUIPMENT (VAN, TANK, FLAT, ETC..)	DATE FROM	DATE TO	APPROX. NO. OF MILES (TOTAL)
STRAIGHT TRUCK
TRACTOR AND SEMI-TRAILER
TRACTOR - TWO TRAILERS
MOTOR COACH - SCHOOL BUS
OTHER:

LIST STATES OPERATED IN FOR LAST FIVE YEARS:

SHOW SPECIAL COURSES OR TRAINING THAT WILL HELP YOU AS A DRIVER:

WHICH SAFE DRIVING AWARDS DO YOU HOLD AN FROM WHOM?

SHOW ANY TRUCKING, TRANSPORTATION OR OTHER EXPERIENCE THAT MAY HELP IN YOUR WORK FOR THIS COMPANY:

LIST COURSES AND TRAINING OTHER THAN SHOWN ELSEWHERE IN THIS APPLICATION:

LIST SPECIAL EQUIPMENT OR TECHNICAL MATERIALS YOU CAN WORK WITH (OTHER THAN THOSE ALREADY SHOWN):

MISCELLANEOUS INFORMATION

APPLICANT ACKNOWLEDGEMENT

SUBMITTING THIS FORM WILL BE CONSIDERED AN ELECTRONIC SIGNATURE TO THE FOLLOWING:

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 inquires 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.