EMPLOYMENT APPLICATION

( Privacy Statement) Req'd field
Driver Information:
Name:
Social Security #:
Address:
City:
State, Zip:  Zip:
E-Mail:
Phone:
Date of Birth:
Miscellaneous Information:
Have you ever been convicted of a crime?   Yes No    
If yes, explain:
Number of Years working with each:
Intermodal
 Van
 Tanker
 Flatbed
Other (& Years): 
Reference Name:
Phone:
Current Emploment Information
Current Employer:
City
State:  Zip:
Phone:
Contact:
Position:
Employment Yrs: to:
Pay Rate:
Why did you leave?
Past Employment Information:
Employer:
City:
State:  Zip:
Phone:
Contact:
Position:
Employment Yrs: to:
Pay Rate:
Why did you leave?
Employer:
City:
State:  Zip:
Phone:
Contact:
Position:
Employment Yrs: to:
Pay Rate:
Why did you leave?
I certify that I personally completed this application and that all information is true and correct. I authorize Rail Delivery to conduct a thorough background investigation in accordance with state and federal law and authorize my previous EMs to release any information requested by Rail Delivery and hold them harmless of all liability from the release of said information. Also, in accordance with the provisions of 49 CFR Part 382.405 and 382.413, I hereby authorize and require my previous and/or current EMs specifically listed by me on this application to release the results (including any refusal to test) of all drug and alcohol tests taken by me pursuant to the provision of 49 CFR while in their employment, to Rail Delivery by whatever means is most expedient.

I  accept the certification terms:     No     Yes

 
Rail Delivery Services
8600 Banana Avenue, Fontana CA 92335
Phone: (909) 355-4100 • Administrative FAX: (909) 822-3135 • Dispatch FAX: (909) 822-3140  • Email: info@raildelivery.com
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