Application for Qualification
- Maintenance & Staff -
In compliance with Federal and State equal opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, gender, national origin, age, marital status, or non-job related disability.
* Indicates required field. Date of Application:  09/08/2010
Personal Information
* First Name: * Middle Name: * Last Name:
* Primary Phone: (XXX-XXX-XXXX) Alternate Phone: (XXX-XXX-XXXX)
Email Address: * Date of Birth: (MM/DD/YYYY)
List addresses of residency for the past three (3) years.
Current Residence
* Address: * City:
County: * State: * Zip Code:
 Check here if no further Residence information can be supplied.
Previous Residence 1
* Address: * City:
County: * State: * Zip Code:
 Check here if no further Residence information can be supplied.
Previous Residence 2
* Address: * City:
County: * State: * Zip Code:
 Click here if no further Residence information can be supplied.
Drivers License & Endorsements
Drivers License Class: Drivers License State: Expiration Date: (MM/DD/YYYY)
Check all the endorsements that apply
 (T) Double/Triple  (P) Passenger  (N) Tank  (H) HAZMAT  (X) Tank/HAZMAT
General Information
* Position Applying For: * Shift Preferred: * Status: * Date Available: (MM/DD/YYYY)
* Do you have a legal right to work in the United States? Yes No
* Have you worked for this company before? Yes No   When?  (MM/YYYY)
* Are you of legal age to work? Yes No
* Have you been convicted of a criminal offense, including felony? Yes No
Criminal Offense 1
* Date: (MM/YYYY) * Location: * Offense:
 Check here if no further Criminal Offense information can be supplied.
Criminal Offense 2
* Date: (MM/YYYY) * Location: * Offense:
 Check here if no further Criminal Offense information can be supplied.
Criminal Offense 3
* Date: (MM/YYYY) * Location: * Offense:
 Check here if no further Criminal Offense information can be supplied.
Criminal Offense 4
* Date: (MM/YYYY) * Location: * Offense:
 Check here if no further Criminal Offense information can be supplied.
Criminal Offense 5
* Date: (MM/YYYY) * Location: * Offense:
 Check here if no further Criminal Offense information can be supplied.
Is there any reason you might be unable to perform the functions of the job applying for? Yes No
Explain if you wish.
Educational Background
Grammar School
Name: Address:
Years Completed: Date of Graduation: (MM/YYYY)
High School
Name: Address:
Years Completed: Date of Graduation: (MM/YYYY)
College
Name: Address:
Course of Study: Years Completed:
GPA: Date of Graduation: (MM/YYYY)
Graduate School
Name: Address:
Course of Study: Years Completed:
GPA: Date of Graduation: (MM/YYYY)
Vocational Training or other
Name: Address:
Course of Study: Years Completed:
GPA: Date of Graduation: (MM/YYYY)
Employment History
List last(most recent)employer first, including U.S. Military Service.
 Check here if you have no employment history.
Employer 1
* Name: * From: (MM/YYYY) * To: (MM/YYYY)
Address: Position Held:
* City: * State: Zip Code: Wage: Rate:
Contact Person: Phone Number: (XXX-XXX-XXXX) Reason for Leaving:
Types of Equipment Used:
 Check here if no further Employer information can be supplied.
Employer 2
* Name: * From: (MM/YYYY) * To: (MM/YYYY)
Address: Position Held:
* City: * State: Zip Code: Wage: Rate:
Contact Person: Phone Number: (XXX-XXX-XXXX) Reason for Leaving:
Types of Equipment Used:
 Check here if no further Employer information can be supplied.
Employer 3
* Name: * From: (MM/YYYY) * To: (MM/YYYY)
Address: Position Held:
* City: * State: Zip Code: Wage: Rate:
Contact Person: Phone Number: (XXX-XXX-XXXX) Reason for Leaving:
Types of Equipment Used:
 Check here if no further Employer information can be supplied.
Employer 4
* Name: * From: (MM/YYYY) * To: (MM/YYYY)
Address: Position Held:
* City: * State: Zip Code: Wage: Rate:
Contact Person: Phone Number: (XXX-XXX-XXXX) Reason for Leaving:
Types of Equipment Used:
 Check here if no further Employer information can be supplied.
Employer 5
* Name: * From: (MM/YYYY) * To: (MM/YYYY)
Address: Position Held:
* City: * State: Zip Code: Wage: Rate:
Contact Person: Phone Number: (XXX-XXX-XXXX) Reason for Leaving:
Types of Equipment Used:
 Check here if no further Employer information can be supplied.
How/who referred you to Fort Transfer?
Specialized Skills & Qualifications
Please list any specialized training, skills or certifications you've obtained that you feel are relevant to the job for which you are applying.
Terms & Conditions

The facts set forth in my application are true and correct.  I understand that, if employed, false statements on this application will be considered sufficient cause for dismissal.  I hereby authorize Fort Transfer Company or its agents to make an investigation of my employment and personal history through any investigative or credit agencies of its choice.  I understand, also, that I am required to abide by all rules and regulations of Fort Transfer Company.

I also understand that neither this application nor a commitment of employment by Fort Transfer Company constitutes a contract of employment.  If a contract is to exist, that document will be executed in writing by Fort Transfer Company.  I understand that this application for employment is valid for no more than 30 days.   After that, I must resubmit an application in order to be considered for positions at Fort Transfer Company.   I agree, if hired, to furnish such additional information and complete such examinations as may be required to complete my employment file.

By submitting this application, I signify that I have read and agree to the terms set forth in the disclaimer.