APPLICANT NOTE:
This application is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all questions completely and accurately. False or misleading statements during an interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, color, age, national origin, sexual orientation, veteran status, military reserve membership, ancestry, religion, the presence of disabilities or any other characteristic prohibited by law.

If you have worked for Larry Williams Trucking in the past, please complete items below:

A. Dates of Employment

If any members of your family have worked for Larry Williams Trucking in the past, please complete items A through C below:


YesNo


YesNo

If so, please describe in the boxes below:


YesNo

EDUCATION


YesNo


YesNo

DRIVER EXPERIENCE

Please list your past 3 accidents and state whether in a personal or commercial vehicle.


YesNo


YesNo

All prospective employees engaged in a safety-sensitive function must submit to a pre-employment drug screen.

Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you have applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?
YesNo

PREVIOUS EMPLOYMENT


YesNo


YesNo


YesNo

DISCLAIMER*


Yes