RAD Transport Inc.

ONLINE APPLICATION

TOW AWAY

DRIVE AWAY

HAUL AWAY

Employment Application

In compliance 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 disability.

Position Applied for:

Applicants Full Name: Phone Number

List your addresses of residency for the past three years

Current Address

Street:

City: Zip: State: How Long

Previous Address

Street:

City: Zip: State: How Long

Street:

City: Zip: State: How Long

Street:

City: Zip: State: How Long

Do you have the legal rights to work in the United States?

Date of Birth: Can you provide proof of age?

(REQIRED FOR COMMERCIAL DRIVERS)

Have you worked for this company before?

If yes please give us the dates you worked. From: To:

Position: Rate of Pay:

Reason for leaving:

Are you now employed? If not, how long since leaving your last employer?

Who refered you: Rate of pay expected:

Is there any reason you might be unable to perform the functions of the job you have applied

(as described in job description). If yes explain:

Previous employment history MUST go back 10 years. Qualified applicants will have AT LEAST 3 years experience within that 10 years.

LAST EMPLOYER

DATE

Name :

From : To:

Address :

Position Held :

City : State :

Zip :

Salary/Wage :

Contact Person :

Phone :

Reason For Leaving :

LAST EMPLOYER

DATE

Name :

From : To:

Address :

Position Held :

City : State :

Zip :

Salary/Wage :

Contact Person :

Phone :

Reason For Leaving :

LAST EMPLOYER

DATE

Name :

From : To:

Address :

Position Held :

City : State :

Zip :

Salary/Wage :

Contact Person :

Phone :

Reason For Leaving :

RECORD OF ACCIDENTS AND CONVICTIONS

Accident record for past three years

DATES

NATURE (head-on, etc.)

FATALITIES

INJURIES

Last Accident :

YesNo

YesNo

Next Previous :

YesNo

YesNo

Next Previous :

YesNo

YesNo

TRAFFIC CONVICTIONS AND FORFEITURES FOR PAST 3 YEARS

( Other than parking violations )

LOCATION

DATE

CHARGE

PENALTY

MONTHYEAR

MONTHYEAR

INDICATE HIGHEST GRADE COMPLETED

9     10     11     12

COLLEGE

1     2     3     4

Last School Attended

A Commercial Drivers License ( CDL ) is preferred. Class A, B, or C, with or without Airbrake endorsment(s).

LIST ALL DRIVERS LICENSES FROM PAST THREE YEAES

STATE

LICENSE NUMBER

TYPE

EXPIRATION DATE

MONTHYEAR

MONTHYEAR

MONTHYEAR

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?     Yes     No

B. Has any license, permit or privilege ever been suspended or revoked?      Yes     No

DRIVING EXPERIENCE

CLASS OF EQUIPMENT

TYPE OF EQUIPMENT

DATES OF EXPERIENCE

APPROX. NO. OF MILEES (TOTAL)

Straight Truck

From :

To:

Tractor and Semi-Trailer

From :

To:

Tractor - Two Trailers

From :

To:

Other

From :

To:

Type of Truck to Lease on Year Make and Model

List states operated in for the last five years.

Show special courses or training that will help you as a driver.

Which safe driving awards do you hold and who from?

**EXPERIENCE AND QUALIFICATIONS - OTHER**

Show any, Trucking, Transportation, or other experience that mau help in providing services to this company.

List Special equipment ot Technical Materials you can work with ( other than those already shown )

Did you read and do you have all the required equiptment as stated under Qualifications? YesNo

NOTE: If you do not or cannot meet all the truck and experience requirements, do not apply.

TO BE READ AND ACKNOWLEDGED BY APPLICANT

This certifies this application was completed by me, and all the entries on it and information in it are true and complete to the best of my knowledge.

I authorize you to take such investigations and inquiries of my personal, employment, financial or medical historyand other related matters as may be necessary in arriving at an employment decision. ( Generally, inquiries regarding medical historywill be made only if and after a conditional offer of employmenthas 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) mat result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company

I have read and acknowledge the above statement. Date