Job Application - Wealing Brothers

Employment Application

In Compliance with Federal and State equal opportunity laws, qualified applications are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, disability, sexual orientation, or any other class protected bylaw.

Name

This field is for validation purposes and should be left unchanged.

Your Name(Required)

First Last

Your Email Address(Required)

Enter Email Confirm Email

Phone

Date of Birth(Required)

Social Security No.

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Have you lived at this address for 3 or more years?

If no, please lists address for the past 3 years with most recent first:

Position Desired(Required)

Applying for a CDL position?(Required)

Salary/wages expected?

Do you have a valid driver's license?(Required)

License Number

State

Expiration Date

Is it a commercial driver's license (CDL)?

Have you held a license in another state?

License Number

State

Do you own your own vehicle?(Required)

If no, do you have reliable transportation?(Required)

Have you completed the OSHA course and obtained a 10-hour OSHA card?(Required)

Grade of License:

Are you legally authorized to work in the U.S.?(Required)

Note: you will be required to furnish documents to verify your eligibility for employment in accordance with the Immigration Reform and Control Act and your employment is contingent upon furnishing such documents.

Is there any reason you might be unable to perform the functions of the job for which you have applied?(Required)

If yes, explain if you wish:

Note: This company does not discriminate on the basis of physical or mental handicap.

Are you now receiving compensation for occupational injury or illness?

If yes, explain if you wish:

Note: Occupational Injury or illness is not a bar to employment - all circumstances will be considered.

Have you ever been convicted of a crime that has not been annulled by a court?(Required)

If yes, please explain:

Note: Conviction of a crime is not a bar to employment - all circumstances will be considered.

Have you ever failed a pre-employment drug or alcohol test for an employer with whom you never obtained employment?(Required)

Have you ever been employed by this company?(Required)

Dates employed:

Position Held:

Rate of pay:

Reason for leaving:

Are you employed now?(Required)

If not, how long since your last employment?

Who referred you to our company or how did you hear about us?(Required)

In Case of Emergency, Contact:

Name

First Last

Relationship

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work References

Please provide the names and addresses of each person and/or company for whom you worked during the past 10 years. The information provided below may be used to contact your previous employer(s) for the purpose of investigating your safety performance history. Note: List employers in reverse order, starting with the most recent.

Employer name:

Employed from:

Position held:

Direct Supervisor:

Salary/Wages:

Hours worked per week:

Telephone No.

Reason for leaving:

Were you subject to the FMCSR while employed by this employer?

Was this position designated as a DOT *safety sensitive function* subject to alcohol and drug testing as required by 49 CFR Part 40?

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer name:

Employed from:

Position held:

Direct Supervisor:

Salary/Wages:

Hours worked per week:

Telephone No.

Reason for leaving:

Were you subject to the FMCSR while employed by this employer?

Was this position designated as a DOT *safety sensitive function* subject to alcohol and drug testing as required by 49 CFR Part 40?

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer name:

Employed from:

Position held:

Direct Supervisor:

Salary/Wages:

Hours worked per week:

Telephone No.

Reason for leaving:

Were you subject to the FMCSR while employed by this employer?

Was this position designated as a DOT *safety sensitive function* subject to alcohol and drug testing as required by 49 CFR Part 40?

Address

Street Address Address Line 2 City State ZIP Code

Personal References

Please provide (3) personal references (persons who are not related to you) that have known you for at least 1 year.

Personal References

Name

Address

Phone

Relationship

Education

High School

City

State

Graduate?

If no, how many years completed?

College/University

City

State

Graduate?

If no, how many years completed?

Vocational/Business School

City

State

Graduate?

If no, how many years completed?

Skills

Do you have any agriculture experience?(Required)

If yes, please provide a brief explanation:

Do you have any vehicle maintenance/repair experience?(Required)

If yes, please provide a brief explanation:

Please list any additional training or skills that you would like us to consider:

Additional Information Required for CDL Positions Pursuant to Federal Motor Carrier Safety Regulation 391.21

Answer the following sections only if you are applying for a driver position.

Accidents

Accident record past three(3) years or more. Please list in most recent order. If none, please write none.

Date

Nature of Accident (Head on, Rear-end, etc.)

Any fatalities?

Any injuries?

Traffic Convictions

Traffic Convictions and forfeitures for the past three(3) years (other than parking violations). If none, please write none.

Date

Location

Charge

Penalty

Qualifications - Driver Licenses

State

License No.

Class

Endorsements

Restrictions

Exp. Date

Please provide the following information about your driving experience.

Class of vehicle

Type of equipment

Date

Approx. No. of Miles Total

Have you ever been denied a license, permit or privilege to operate a vehicle?(Required)

If yes, please explain:

Have you ever had a license, permit or privilege suspended or revoked?(Required)

If yes, please explain:

Have you ever been disqualified for violations of the FMCSR's?(Required)

If yes, please explain:

Corporate Address:

4161 North 600 East
Fowler, Indiana 47944

Phone: (219) 261-2520

Email: [email protected]

Website by

Employment Application

In Case of Emergency, Contact:

Work References

Personal References

Education

Skills

Additional Information Required for CDL Positions Pursuant to Federal Motor Carrier Safety Regulation 391.21

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