EMPLOYMENT APPLICATION

First Name *

Middle Initial

Last Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address

Social Security Number *

Information is securely encrypted for your protection

Date of Birth *

Example - July 27, 1973

CDL # *

CDL State Issued *

CDL Expiration Date *

Years of Driving Experience *

Have You Ever Been Convicted of a Felony?

Yes
No

Number of Moving Violations in Last 3 Years *

Any Accidents in Last 3 Years?

Yes
No

Current Employer *

If doesn't apply please enter "N/A"

City *

If doesn't apply please enter "N/A"

State *

If doesn't apply please enter "N/A"

Contact Name *

If doesn't apply please enter "N/A"

Phone Number *

If doesn't apply please enter "N/A"

Starting Date *

If doesn't apply please enter "N/A"

Ending Date *

If doesn't apply please enter "N/A"

Ending Pay *

If doesn't apply please enter "N/A"

Previous Employer *

If doesn't apply please enter "N/A"

City *

If doesn't apply please enter "N/A"

State *

If doesn't apply please enter "N/A"

Contact Name *

If doesn't apply please enter "N/A"

Phone Number *

If doesn't apply please enter "N/A"

Starting Date *

If doesn't apply please enter "N/A"

Ending Date *

If doesn't apply please enter "N/A"

Ending Pay *

If doesn't apply please enter "N/A"

Previous Employer *

If doesn't apply please enter "N/A"

City *

If doesn't apply please enter "N/A"

State *

If doesn't apply please enter "N/A"

Contact Name *

If doesn't apply please enter "N/A"

Phone Number *

If doesn't apply please enter "N/A"

Starting Date *

If doesn't apply please enter "N/A"

Ending Date *

If doesn't apply please enter "N/A"

Ending Pay *

If doesn't apply please enter "N/A"

SSL

This form is secured through SSL and CAPTCHA Protection.

Social Security Number MUST be included in order to run MVR

I certify that all information is true and correct. I authorize A.L. Smith Trucking, Inc. to conduct a thorough background investigation in accordance with state and federal law and authorize my former employer to release any information requested by A.L. Smith Trucking, Inc. and hold them harmless of all liability from the release of said information, which includes drug/alcohol test results as required by 49 CFR Prt 382.413.