Job Application Thank you for your interest in Kanaan Trucking Services, LLC. Complete the multi-step application below. Website Introduction Driver Info Employment History Driving Experience Accident Record Traffic Convictions Driver's License Job References Upload Documents Page 1. Introduction Thank you for your interest in Kanaan Trucking Services, LLC. To apply for a driving position, please complete our online application for employment. Incomplete information will delay the processing of your application or prevent it from being submitted. In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, national origin, age, sex, marital status, veteran status, non-job related disability, or any other protected group status. Before You Start Social Security Number Home address history for the past 3 years Current driver's license number and driver's license history for the past 3 years Employment history up to 10 years Traffic accidents, violations, and / or convictions from the last 5 years, including DUI, reckless driving convictions, and license suspensions Military history (if applicable) Required Attachments Front of CDL driver's license Back of CDL driver's license Current medical card Required entry fields are followed by *, meaning you must provide the requested information to continue. If you encounter any errors during this process and cannot continue, please contact us at 336-553-6570. Next Page 2. Driver Info Legal Full Name * Position Applying For * Select one Contractor Driver Contractor's Driver Phone * Emergency Phone Number Provide your Email Address * DOB *// SSN * Physical Exam Expiration Date *// Current Address Street * Unit City * State * Select StateALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYDC Zipcode * Previous 3 Years Addresses Address 1 Street Unit City State Select StateALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYDC Zipcode Add Address Have you worked for this company before? Yes No If yes, give dates: From// To// Reason for leaving? Education History Select all that apply: Grade School College Post Graduate PreviousNext Page 3. Employment History Give a COMPLETE RECORD of all employment for the past three (3) years, including any unemployment or self employment periods, and all commercial driving experience for the past ten (10) years. Start with your current or most recent job. Employment Sections Employment 1 Employer Name Starting Date// Ending Date// Position Held Reason for leaving Company Phone Were you subject to FMCSRs while employed here? Yes No Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? Yes No Address - Street Unit City State Select StateALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYDC Zipcode Add Next Employment PreviousNext Page 4. Driving Experience Straight Truck From// To// Approximate Number of Miles Tractor & Semi-trailer From// To// Approximate Number of Miles Tractor & two trailers From// To// Approximate Number of Miles Tractor & triple trailers From// To// Approximate Number of Miles Other From// To// Approximate Number of Miles List states operated in, for the last five (5) years List special courses/training completed (PTD/DDC, HAZMAT, ETC) List any Safe Driving Awards you hold and from whom PreviousNext Page 5. Accident Record Accident Record for past three (3) years (attach sheet if more space is needed). Accident 1 Date of Accident// Location of Accident # of Fatalities # of People Injured Nature of Accidents (Head on, rear end, etc) Add Accident PreviousNext Page 6. Traffic Convictions Traffic Convictions and Forfeitures for the last three (3) years (other than parking violations). Traffic Record 1 Date// Location Charge($) Penalty($) Add Traffic Record PreviousNext Page 7. Driver's License Driver's License (list each driver's license held in the past three (3) years). Upload the front and back of your CDL license on this page. License Record 1 CDL Driving Experience - Years * Select Years01234567891011121314151617181920 CDL Driving Experience - Months * Select Months01234567891011 State * Select StateALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYDC License # * Type * Select Type CDL Class A CDL Class B Endorsements Expiration Date *// CDL License Front * CDL License Back * Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No Has any license, permit or privilege ever been suspended or revoked? Yes No Is there any reason you might be unable to perform the functions of the job? Yes No Have you ever been convicted of a felony? Yes No If the answers to any questions listed above are "yes", give details PreviousNext Page 8. Job References List three (3) persons for references, other than family members, who have knowledge of your safety habits. Reference 1 Name Street Unit City State Select StateALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYDC Zipcode Phone Reference 2 Name Street Unit City State Select StateALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYDC Zipcode Phone Reference 3 Name Street Unit City State Select StateALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYDC Zipcode Phone PreviousNext Page 9. Upload Documents To Be Read and Signed by Applicant Any misrepresentation on this application is considered an act of dishonesty. The motor carrier or its agents may investigate my background and I release employers and persons named herein from liability for furnishing information. Under the Fair Credit Reporting Act (Public Law 91-508), this investigation may include an Investigative Consumer Report about character, reputation, personal characteristics, and mode of living. I agree to provide additional information and complete examinations required to complete my application file. This application does not obligate the motor carrier to employ or hire me. If qualified and hired, I may be on a probationary period and may be disqualified without recourse. Certification: This application was completed by me, and all entries and information are true and complete to the best of my knowledge. Signature (type full name) * Medical Card * Additional File Uploads (optional) Required attachment on this page: medical card. You may also attach additional files. Allowed: jpeg, jpg, png, pdf. Total attachments limit: 30MB. PreviousSubmit Application
