In compliance with Federal and State equal employment opportunity laws, qualified applicants are
considered for all positions without regard to race, religion, sex, national origin, age, marital status,
veteran status, non-job related disability or any other protected group status.



Personal Information

Date:   02/22/2012 Telephone #: Cell Phone #: First Name: Middle Name: Last Name: Social Sec. #: Date of Birth: Must Provide 3 Years: Driver's License #: Type: A B C D E Issuing State: AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Driver's License #: Type: A B C D E Issuing State: AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Must Provide 3 Years: Current Address: City: State:   AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY    Zip:   How long at this address? Previous Address: City: State:   AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY    Zip:   How long at this address? Have you ever worked for Windy Hill before? Yes   No If yes, when?  (MM/YYYY) / to / Emergency Contact: Name: Phone #: Do you have the legal right to work in the United States? Yes   No All Interstate Drivers must provide information on employers for the previous 10 years. May we contact your current employer? Yes   No Current/Most Recent Employer Employer: Dates:  (MM/YYYY) / to / Phone #: Position(s): Address: Reason(s) for leaving: City/State/Zip: Salary/Wage: Contact: Are you subject to the FMCSRs while employed?       Yes   No Is your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirments of 49 CRF part 40?       Yes   No Previous Employer Employer: Dates:  (MM/YYYY) / to / Phone #: Position(s): Address: Reason(s) for leaving: City/State/Zip: Salary/Wage: Contact: Were you subject to the FMCSRs while employed?       Yes   No Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirments of 49 CRF part 40?       Yes   No Previous Employer Employer: Dates:  (MM/YYYY) / to / Phone #: Position(s): Address: Reason(s) for leaving: City/State/Zip: Salary/Wage: Contact: Were you subject to the FMCSRs while employed?       Yes   No Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirments of 49 CRF part 40?       Yes   No Previous Employer Employer: Dates:  (MM/YYYY) / to / Phone #: Position(s): Address: Reason(s) for leaving: City/State/Zip: Salary/Wage: Contact: Were you subject to the FMCSRs while employed?       Yes   No Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirments of 49 CRF part 40?       Yes   No Previous Employer Employer: Dates:  (MM/YYYY) / to / Phone #: Position(s): Address: Reason(s) for leaving: City/State/Zip: Salary/Wage: Contact: Were you subject to the FMCSRs while employed?       Yes   No Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirments of 49 CRF part 40?       Yes   No Were you referred by a current employee? If so, who? Name: Truck #: A Conviction is not an automatic bar to employment. All circumstances will be considered. Have you ever had a Felony Conviction? Yes   No If yes, please explain: Have you ever had a Misdemeanor Conviction? Yes   No If yes, please explain: Have you ever violated any of the DOT laws governing drug and/or alcohol use? Yes   No If yes, please explain: Have you ever failed a drug or alcohol test? (please include pre-employment tests) Yes   No Have you ever had a DUI, DWI or alcohol-related incident? Yes   No If yes, please explain: Driving Record: Accident Information Date: Nature of Accident: Charge: Penalty: Date: Nature of Accident: Charge: Penalty: Date: Nature of Accident: Charge: Penalty: Traffic Convictions (last 5 years) Date: Charge: Location: Penalty: Date: Charge: Location: Penalty: Date: Charge: Location: Penalty: Date: Charge: Location: Penalty: Are you able to move freight weighing up to 75 lbs. per piece from floor level or shoulder level to a distance of more than 53 feet?       Yes   No Couple and uncouple combination vehicles as required? This involves repetitious turning of trailer dolly handle (crank) to raise and lower trailer supports and to operate the release lever of a 5th wheel       Yes   No Climb in and out of an over-the-road tractor 8-10 times a day?       Yes   No Fuel and perform basic maintenance checks on a tractor and trailer?       Yes   No Can you read, write and speak English sufficiently to converse with the general public, understand highway and traffic signs/signals, respond to official inquiries, read a bill of lading and make accurate entries on paperwork required by the Federal Motor Carrier Safety Regulations and company policy?       Yes   No Conduct minor repairs of commercial motor vehicles following company procedures at the direction of company personnel?       Yes   No Have the necessary professional driving skills to operate a commercial combination vehicle at varying speeds in difficult situations that may include but are not limited to, heavy traffic, inclement weather or at shipper/receiver locations that may include difficult docking situations?       Yes   No Perform other duties as assigned?       Yes   No By checking the "I agree" box I certify that I personally completed this application and that all of the information is true and correct. I hereby request and authorize any company that receives this application to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, mode of living, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed this application of my own free will and hold Windy Hill Foliage, Inc. harmless of all liability for providing this application for my use. I agree