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Your employment
Application will be kept on file for 1 year from online submittal Date |
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Southco Distributing Company
Online Driver Application |
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Last Name |
First Name |
Middle Initial |
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Date of Birth: |
Can you provide documentation to
verify Date of Birth? Yes
No |
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Home Phone # |
Friend / Neighbor
Phone # |
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| Current Address |
City |
State |
ZipCode |
How Long
Years/Months |
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| Previous Address |
City |
State |
ZipCode |
How Long
Years/Months |
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| License Information |
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Drivers Licenses |
State |
License Number |
Type |
Expiration Date |
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Driving Experience |
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Class of Equipment |
Type of Equipment |
Dates |
Approximate Number of
Miles (Total) |
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(Van, Tanker, Flat, Etc.) |
From |
To |
| Straight Truck |
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| Tractor / Semi Trailer |
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| Tractor / Two Trailers |
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| Other |
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Accident Record (Additional Remarks Section at the
bottom of this form if you need more space to complete this section) |
| Type |
Date |
Accident
Detail
(Head-on, Rear-end, Upset, etc.) |
Fatalities |
Injuries |
| Last Accident |
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Yes
No |
Yes
No |
| Next Previous |
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Yes
No |
Yes
No |
| Next Previous |
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Yes
No |
Yes
No |
| Next Previous |
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Yes
No |
Yes
No |
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Traffic Conviction / Forfeitures (Other than
parking violations, additional remarks section at the bottom of this for
if more space is needed) |
| Location |
Date |
Charge |
Penalty |
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| 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 |
| If the answer to either of the above
questions is Yes, please give details on the remarks section at the
bottom of this form. |
| Drivers for Southco
Distributing Company may be required to travel overnight on certain
routes. Would this be a problem for you?
Yes
No |
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Employment History (List in reverse chronological order with last employer first) |
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1. Most recent employer |
Employment Dates |
Job Title |
Supervisor(s) Name |
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(Company Name) |
From |
To |
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Company address: |
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Phone number: |
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Position(s) held: |
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Reason for leaving: |
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Describe Duties: |
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2. Next recent employer |
Employment Dates |
Job Title |
Supervisor(s) Name |
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(Company Name) |
From |
To |
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Company address: |
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Phone number: |
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Position(s) held: |
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Reason for leaving: |
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Describe Duties: |
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3. Next recent employer |
Employment Dates |
Job Title |
Supervisor(s) Name |
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(Company Name) |
From |
To |
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Company address: |
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Phone number: |
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Position(s) held: |
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Reason for leaving: |
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Describe Duties: |
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| Do you have a
WorkKeys Career Readiness Certificate (CRC)?
Yes
No |
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www.waynecc.edu/works If yes, what is your Career Readiness
Certificate level? |
| Additional
Remarks from sections above |
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| Date you could start
at Southco: |
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Expected Salary: |
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Date: |