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J & B Distributors, Inc.
1216 N. Buchanan St.
Green Bay, WI 54303
(920) 494-4202

Drivers Application for Employment

Click Here to Download a Printable Application

The information you provide is secured by:  

Entry fields highlighted in red are required.

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 disabilty.

   
Name (First, Middle Initial, Last)
Position Applied For
Home Phone, Mobile Phone
E-mail
Date of Birth
Social Security Number
 

List your addresses of residency for the past 3 years.

Current Address
City, State, Zip
Years at Address
Previous Address
City, State, Zip
Years at Address
Previous Address
City, State, Zip
Years at Address
Previous Address
City, State, Zip
Years at Address
 

 

Do you have the legal right to work in the United States?
Can you provide proof of age?
Have you worked for this company before?
If Yes, where?
Date of Employment (Start, Finish)
Rate Of Pay
Position Held
Reason for leaving?
Are you currently employed?
If not, how long since leaving last employment?
Who reffered you?
Rate of Pay expected
Is there any reason you might be unable to perform the funtions of the job for which you have applied?
If yes, explain if you wish.
 

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information
on all employers during the proceding 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 of information on those employers
for whom the applicant operated such vehicle.

(Note: List employers in reverse order starting with the most recent.)

Employer

Street Address
City, State, Zip
Contact Person
Phone Number
In this job did you have any
safety sensitive functions?
If yes, explain.
Employment Start Date (Month/Year)
Employment End Date (Month/Year)
Position Held
Salary / Wage
Reason for leaving?
 

Employer

Street Address
City, State, Zip
Contact Person
Phone Number
In this job did you have any
safety sensitive functions?
If yes, explain.
Employment Start Date (Month/Year)
Employment End Date (Month/Year)
Position Held
Salary / Wage
Reason for leaving?
 

Employer

Street Address
City, State, Zip
Contact Person
Phone Number
In this job did you have any
safety sensitive functions?
If yes, explain.
Employment Start Date (Month/Year)
Employment End Date (Month/Year)
Position Held
Salary / Wage
Reason for leaving?
 

Employer

Street Address
City, State, Zip
Contact Person
Phone Number
In this job did you have any
safety sensitive functions?
If yes, explain.
Employment Start Date (Month/Year)
Employment End Date (Month/Year)
Position Held
Salary / Wage
Reason for leaving?
 

Employer

Street Address
City, State, Zip
Contact Person
Phone Number
In this job did you have any
safety sensitive functions?
If yes, explain.
Employment Start Date (Month/Year)
Employment End Date (Month/Year)
Position Held
Salary / Wage
Reason for leaving?
 

* Includes vehicles having a GVRW 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.

 

ACCIDENT RECORD

Report all accidents for the past 3 years or more.

(If none, write none.)

Date of last accident
Nature of accident
(Head-On, Read-End, Upset, Etc.)
Were there any injuries as a result of this accident?
Were there any fatalities as a result of this accident?
 

Date of next previous accident
Nature of accident
(Head-On, Read-End, Upset, Etc.)
Were there any injuries as a result of this accident?
Were there any fatalities as a result of this accident?
 

Date of next previous accident
Nature of accident
(Head-On, Read-End, Upset, Etc.)
Were there any injuries as a result of this accident?
Were there any fatalities as a result of this accident?
 

TRAFFIC CONVICTIONS AND FORFEITURES

Report all traffic violations (other than parking tickests) for the past 3 years.

(If none, write none.)

Date of violation
Location
Violation charged with
Penalty
 

Date of violation
Location
Violation charged with
Penalty
 

Date of violation
Location
Violation charged with
Penalty
 

EDUCATION

Highest grade completed:
Years of college completed:
Last School Attended
City, State
 

EXPERIENCE AND QUALIFICATIONS - DRIVER

Drivers License Number
Issuing State
Type / Class
Expiration Date
 

Drivers License Number
Issuing State
Type / Class
Expiration Date
 

Drivers License Number
Issuing State
Type / Class
Expiration Date
 

Have you ever been denied a license, permit or priviledge to operate a motor vehicle?
Has any license, permit or priveledge ever been suspended or revoked?
Have you ever tested positive for a drug / alcohol test within the past 3 years?
If yes to any of the previous three questions, explain here.

Please list your experience with the following equipment types:

Straight Truck (Start Date, End Date)
Tractor and Semi-Trailer (Start Date, End Date)
Tractor - Two Trailers (Start Date, End Date)
Motorcoach - School Bus (Start Date, End Date)
Other (Start Date, End Date)
List other equipment operated
List states operated in for last five years.
List any special courses or training you have received that will help you as a driver.
Which safe driving awards do you hold, and from whom?
 

EXPERIENCE AND QUALIFICATIONS - OTHER

List any trucking, transportation or other experience that may help in you 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)
 

Please use the following space to include any addition information regarding Employment History, Education, Experience, and Qualifications.
 

To be read by applicant before submitting your application.

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 INQUIRIES OF MY PERSONAL, EMPLOYMENT, DOT-PSP, MVR, FINANCIAL, MEDICAL HISTORY, AND OTHER RELATED MATTERS AS MAY BE NECESSARY IN ARRIVING AT AN EMPLOYMENT DECISION. (GENERAL, 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.

By pressing the SUBMIT button you acknowledged you read and agreed with the above and hereby authorize verification of my information.

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