Application for Employment

No application shall be accepted that is not complete. Please ensure that you are properly prepared to complete this application. This includes full names, addresses, zip codes, and telephone numbers where indicated. Incomplete or unreadable applications will be rejected.

NAME:

Street Address

City

State

Zip

CELL PHONE:

HOME PHONE:

SOCIAL SECURITY NUMBER:

DATE OF BIRTH:

DRIVER LICENSE NO:

STATE:

CLASS:

EXPIRES:

Employment Desired

Position you are applying for:

Date you can start:

Full Time
Part Time

The position you are applying for will require you to work days, nights, weekends and holidays. Please list any hours or days that you are unavailable for work:

The position you are applying for will require you to work overtime. Is this a problem ?

Yes
No

The position you are applying for will require you to travel for extended periods. Is this a problem?

Yes
No

Starting Salary Desired:

Personal Information

Have you ever applied for employment or worked for our company ?

Yes
No

If your answer to the above question was "YES", when and where:

Do you have any friends or family members that are currently employed at our company ?

Yes
No

If your answer to the above question was "YES", who and where:

How did you hear about our current job opening ?

If hired, do you have reliable transportation twenty four ( 24 ) hours per day:

Yes
No

Are you at least 21 years of age:

Yes
No

To be considered for employment by our company, you must be at least 21 years of age, be able to provide a minimum of five years verifiable CDL licensed experience, and you must be able to read and speak the English language sufficiently to converse with the general public, to understand highway traffic signs and signals in the English language, to respond to official inquiries, and to make entries on reports and records Per: 391.11(b)(2) U.S. DOT Federal Motor Carrier Safety Regulations.

If hired, you will be required to present evidence of your US citizenship or documentation proving your legal right to both live and work in this country. Are you able to provide such proof ?

Yes
No

Are you physically and mentally able to perform the essential functions of the job that you are applying for ?

Yes
No

If the answer to the above question is "NO", please describe your limitations:

NOTE: Our company complies with the Americans with Disabilities Act ( ADA ) and our company will consider making reasonable accommodations necessary for eligible applicants / employees to perform essential functions. The hiring of such an applicant may be subject to the applicant passing a medical examination and/or skill and agility testing.

Do you speak, write, or understand any foreign languages ?

Yes
No

If yes, which language ?

Do you have any related experience, training, certificates, qualifications, or skills that would benefit our trucking program ?

Yes
No

If yes, please explain:

Have you ever been convicted or plead no-contest to a felony?

Yes
No

Have you ever been convicted or plead no-contest to a misdemeanor?

Yes
No

Have you ever been convicted or plead no-contest as a sexual offender?

Yes
No

Have you ever been convicted or plead no-contest to any criminal offense?

Yes
No

If the answer to any of the above questions is yes, list each conviction by date, offense, location, and disposition:

NOTE: No applicant will be denied employment solely on the grounds of a criminal conviction. The nature of the offense, the severity of the offense, the surrounding circumstances, and the relevance of the offense to the position being applied for may however be considered.

Education - Training - Experience

Name & City of School

Years Completed

Did you graduate?

Diploma Certificate

Name & City of School

Years Completed

Did you graduate?

Diploma Certificate

Name & City of School

Years Completed

Did you graduate?

Diploma Certificate

Name & City of School

Years Completed

Did you graduate?

Diploma Certificate

Military Service

Are you a US Military Veteran ?

Yes
No

Branch of Service:

Were you "Honorably" Discharged ?

Yes
No

Rank at Discharge:

Please list any training or specialty duty that you completed or received during your military service that you feel would be of value to your employment with our company:

Personal References

List below three persons that are not related to you that will have knowledge of your work ethic within the past three years.

NAME:

FULL ADDRESS:

OCCUPATION:

PHONE NUMBER:

NUMBER OF YEARS ACQUAINTED:

Add more

NAME:

FULL ADDRESS:

OCCUPATION:

PHONE NUMBER:

NUMBER OF YEARS ACQUAINTED:

Add more

NAME:

FULL ADDRESS:

OCCUPATION:

PHONE NUMBER:

NUMBER OF YEARS ACQUAINTED:

Please read this section carefully, initial each paragraph, and sign below. Missing initials or signature will disqualify the application.

I herby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that all answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I fully understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed prior to discovery.

Initial Here

I herby authorize this company to thoroughly investigate my references, work record, educational background, and any other maters related to my suitability for employment. I further authorize the references listed to disclose to this company any and all letters, reports, and any other information related to my work record, without giving me prior notice of such a disclosure. In addition, I herby release this company, my former employers, and all other persons, corporations, partnerships and/or associations from any and all claims, demands and liability arising out of or in any way related to such an investigation or disclosure.

Initial Here

I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and this company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or this company, and that no promises or representations contrary to the forgoing are binding on this company unless made in writing and signed by me and this company's designated representative. I also fully understand that while under employment for Lexmar / LDI, I will be put on a 90 day formal probation under which I can be terminated for any reason with or without cause.

Initial Here

By initialing , driver acknowledges that piece rate pay includes (1) 30 minute meal break during his/her shift (up to ten hours) and a second 30 minute meal break after 10 hours if applicable, unless waived. The driver also acknowledges that pay includes a 10 minute rest break every 4 hours worked. Waiver of the second meal break is voluntary and may only be done if: (1) You are working no more than 12 hours; and (2) You took your first 30 minute meal break. Driver also acknowledges that any mileage, route or piece rate compensation includes the time for all rest and meal breaks. Please Note: 15 minute pre-trip, 15 minute post-trip, 2 hours at each shipper and consignee, shop time, time to complete necessary paperwork, and fueling time is included in the mileage and or piece rate.

Initial Here

APPLICANT'S SIGNATURE:

DATE:

APPLICANT'S PRINTED NAME:

Gaio Trucking Form

Employee Change of Information FMCSR Update

EMERGENCY CONTACT INFORMATION

YOU MUST LIST AT LEAST 1 CONTACT

MEDIC ALERT

TRAFFIC CITATIONS

Previous 12 Months

TRAFFIC ACCIDENTS

Previous 12 Months

Application for Employment

Employment Desired

Personal Information

Education - Training - Experience

Military Service

Personal References

CDL Supplemental Application for Employment 391.21 FMCSR

ADDRESS FOR PAST 3 YEARS

EXPERIENCE AND QUALIFICATIONS - DRIVER

DRIVING EXPERIENCE

EMPLOYMENT RECORD