Is there any reason you might be unable to perform functions of the job for which you have applied? If yes, please explain below.Īll driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years from the date this application is submitted. Conviction of a crime is not an automatic bar to employment. Have you ever been convicted of a felony (required) If not, how long since leaving last employment? Have you worked for Payroll & Benefits Admin, Inc in the past? How much experience do you have in years?ĭo you have the legal right to work in the United States? (required) Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.Īre you currently a CDL class A operator? (required) Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer and Review information provided by previous employers I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand, also, that I am required to abide by all rules and regulations of the Company. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. (Generally, 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. I authorize you to make such investigations and inquiries of my personal, employment, financial, or medical history and other related matters as may be necessary in arriving at an employment decision. Employing Company: Payroll & Benefits Admin, IncĬity, State, Zip: Pittston, PA 18640-3725
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