Job Application

Non-CDL Job Application

Please fill out the form below and click “Submit”.

Name *

First

Middle

Last

Email *

Phone *

Social Security Number:

Address *

Address Line 1

Address Line 2

City

State

Zip code

Employment Desired:

Position Applied for:

Date Available:

Rate of Pay Desired:

Check one:

Hour
Week
Month
Year

Do You Desire:

Full time
Part time
Either

Are you willing to work any shift?

Are you willing to travel?

Are you willing to work:

Saturdays
Sundays
Extended Hours
Nights

Have you been employed by this company before?

If YES, please indicate dates / positions:

Have you applied to this company before?

If YES, please indicate postions applied for and dates:

If you are UNDER 18, please enter current age:

Have you ever been CONVICTED of a Felony or a 'Non-Traffic' Misdemeanor?

If YES, please fully explain circumstances and provide date(s):

Please Provide Driver’s License #:

Expiration:

Type of License:

EDUCATION

High School: Name & Address

Graduated:

College: Name, Address, Studies

Graduated:

Tech: Name, Address, Studies

Graduated:

Other: Name, Address, Studies

Graduated:

U.S. Military Service: Are you current or former Military Personnel?

Branch

Rank:

Discharge Type:

List skills / duties / special services that are relevant to the position:

EMPLOYMENT HISTORY: Former Employer #1

Former Employer 1: Company Name / Address / Phone

Former Employer 1: Supervisor Name

Former Employer 1: Dates of Service

Wages:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #2

Former Employer 2: Company Name / Address / Phone

Former Employer 2: Supervisor Name

Former Employer 2: Dates of Service

Wages:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #3:

Former Employer 3: Company Name / Address / Phone

Former Employer 3: Supervisor Name

Former Employer 3: Dates of Service

Wages:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #4:

Former Employer 4: Company Name / Address / Phone

Former Employer 4: Supervisor Name

Former Employer 4: Dates of Service

Wages:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

I UNDERSTAND AND AGREE TO THE FOLLOWING: Authorization of Employment (a) That I authorize the investigation of all statements contained in this application. (b) That the above information is complete and true. Misrepresentation of fact shall constitute just cause for dismissal. (c) To report, if requested to a doctor designated by the company for a physical examination, (post offer), prior to or during my employment. (d) That any offer of employment is conditional on my ability to prove your identity and right to work in the United States. (e) That, if employed, such employment is for no specific duration and may be terminated at any time with or without cause. (f) That I will comply with all rules and regulations as set forth by the company or other communications distributed to all employees. *

First

Last

Department of Motor Vehicle Release: As part of my employment with Baker Rigging, I may volunteer or be asked to drive company vehicles as the need arises. I understand that as a condition to driving a company vehicle, my driving record will be validated through the Department of Motor Vehicles. As further criteria, I understand that if I am convicted of a driving violation, I must notify my supervisor within 5 days. At that time, a determination will be made as to my ability to continue to service as a driver of a company vehicle. *

Name

Department of Motor Vehicle Release Date of Birth: *

Date of Birth:

Department of Motor Vehicle Release Driver's License Number: *

Driver's License Number:

Notice of Required Drug Testing, USIS Background Check and Investigation APPLICANT RELEASE OF INFORMATION AUTHORIZATION AND RIGHTS NOTIFICATION: Applicants background investigative authorization: I hereby authorize Baker Rigging, and/or their agents, to investigate my complete background, regardless of subject, including my controlled substance / alcohol test result history, in order to ascertain that all information given by me is correct. I further release any and all past employers, persons, and organizations from all liability for any damages on account of furnishing any information and agree to indemnify and hold harmless all such persons and organizations who furnish any such information. I understand that if any information provided by me proves to be false and incorrect, termination of my employment or leasing contract may result. This application is not a contract. It is a driver qualification application. In connection with my application for employment (including contract for services) with you, I understand that consumer reports which may contain public record information, may be requested from USIS/DAC Services, Tulsa, Oklahoma. These reports may include the following types of information: names and dates of previous employers, reasons for termination of employment, work experience, accidents, etc. I further understand that such reports may contain public record information concerning my driving record, workers’ compensation claims, safety performance, history records, credit, bankruptcy proceedings, criminal backgrounds, etc., from Federal, State, and other agencies which may maintain such records; as well as information from USIS/DAC Services concerning previous driving record requests made by other (1) I acknowledge notification of my rights regarding investigative information that will be provided to Baker Rigging as follows: *I have the right to review information provided by my previous employers. *I have the right to have errors in the information corrected by my previous employer and for that employer to re-send the corrected information. *I have the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and myself cannot agree on the accuracy of the information. I AUTHORIZE, WITHOUT RESERVATION; ANY PARTY OR AGENCY CONTACTED BY USIS/DAC SERVICES TO FURNISH THE ABOVE MENTIONED INFORMATION: *I Have a right to make a request to USIS/DAC Services, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the receipts of any reports on me which USIS/Dac Services has previously furnished within the three year period preceding my request. I hereby consent to Baker Rigging, obtaining the above information from USIS/DAC Services, and agree that such information which USIS/DAC Services has or obtains, and my employment history with you if I am hired, will be supplied by USIS/DAC Services to other companies that subscribe to USIS/DAC Services. CONTROLLED SUBSTANCE TESTING AUTHORIZATION: In conformity with 49 CFR Part 40, I do hereby authorize Baker Rigging to furnish to USIS/DAC the following information concerning drug and alcohol tests: *DOT drug and alcohol testing violations including pre-employment tests during the past three years; (i) the dates on which I tested positive for drugs and the drugs involved; (ii) the date on which I tested .04 or greater for alcohol, and the test results levels; (iii) the dates on which I refused (including a verified adulterated or substituted result) to be tested for drugs and/or alcohol; (iv) and any other violations of DOT drug and alcohol testing regulations; (v) and any other information Baker Rigging has received regarding violations of drug/alcohol testing regulations from my previous employers in the preceding three years. I hereby agree to submit to drug and alcohol testing per D.O.T. regulations and Baker Rigging pre-employment/leasing policy. Baker Rigging has given me the opportunity to read their Drug and Alcohol Policy in full. I understand that all results are kept confidential. I further understand that a positive test result will make me ineligible to drive for Baker Rigging. I hereby give permission for Baker Rigging to release all (negative and positive) controlled substance and alcohol test results to USIS/DAC Services and/or any company seeking employment/leasing information on my behalf in coordinance with FMCSR Section 391.23. I discharge Baker Rigging from any and all liability in releasing such information. Baker Rigging employees, as a condition of employment, are required to be free from any measurable amounts of illegal drugs, un-prescribed controlled substances. Because Baker Rigging is committed to providing a drug-free working environment for our customers and employees, all offers of employment are contingent upon a urinalysis drug test which indicates that you are free from illegal drugs, and un-prescribed controlled substances. If you are offered a position with Baker Rigging, you will be required to report within 24 hours, with photo identification, to take a urinalysis drug test. The results of this test will be forwarded to the appropriate person at Baker Rigging. USIS services will be used to contact previous employers listed in this application. All alcohol and drug testing performed will be in accordance with required DOT procedures in order to ensure DOT compliance. These include the use of special testing forms, trained personnel, and special handling to insure the integrity and accuracy· of the testing process. I consent freely and voluntarily to the collection and testing of my urine. I authorize the confidential release of laboratory drug test results to Baker Rigging or designee of Baker Rigging at any future date as they are needed. I have read the "Instructions to Applicant Regarding Drug Testing Process" and I understand all the requirements, and I have read or had the opportunity to read the company's drug/alcohol policy. I have read and understand the above:

Name

Notice of Required Drug Testing etc. Social Security Number

Social Security Number

Date

Comment

CDL Job Application

Please fill out the form below and click “Submit”.

Name *

First

Middle

Last

Email *

Phone *

Social Security Number:

Address *

Address Line 1

Address Line 2

City

State

Zip code

Employment Desired:

Position Applied for:

Date Available:

Rate of Pay Desired:

Check one:

Hour
Week
Month
Year

Do You Desire:

Full time
Part time
Either

Are you willing to work any shift?

Are you willing to travel?

Are you willing to work:

Saturdays
Sundays
Extended Hours
Nights

Have you been employed by this company before?

If YES, please indicate dates / positions:

Have you applied to this company before?

If YES, please indicate postions applied for and dates:

If you are UNDER 18, please enter current age:

Have you ever been CONVICTED of a Felony or a 'Non-Traffic' Misdemeanor?

If YES, please fully explain circumstances and provide date(s):

Please Provide Driver’s License #:

Expiration:

Type of License:

EDUCATION

High School: Name & Address

Graduated:

College: Name, Address, Studies

Graduated:

Tech: Name, Address, Studies

Graduated:

Other: Name, Address, Studies

Graduated:

U.S. Military Service: Are you current or former Military Personnel?

Branch

Rank:

Discharge Type:

List skills / duties / special services that are relevant to the position:

EMPLOYMENT HISTORY: Former Employer #1

Former Employer 1: Company Name / Address / Phone

Former Employer 1: Supervisor Name

Former Employer 1: Dates of Service

Wages:

Paid:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #2

Former Employer 2: Company Name / Address / Phone

Former Employer 2: Supervisor Name

Former Employer 2: Dates of Service

Wages:

Paid:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #3:

Former Employer 3: Company Name / Address / Phone

Former Employer 3: Supervisor Name

Former Employer 3: Dates of Service

Wages:

Paid:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #4:

Former Employer 4: Company Name / Address / Phone

Former Employer 4: Supervisor Name (copy)

Former Employer 4: Supervisor Name

Former Employer 4: Dates of Service

Wages:

Paid:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #5:

Former Employer 5: Company Name / Address / Phone

Former Employer 5: Supervisor Name

Former Employer 5: Dates of Service

Wages:

Paid:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #6:

Former Employer 6: Company Name / Address / Phone

Former Employer 6: Supervisor Name

Former Employer 6: Dates of Service

Wages:

Paid:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #7

Former Employer 7: Company Name / Address / Phone

Former Employer 7: Supervisor Name

Former Employer 7: Dates of Service

Wages:

Paid:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #8:

Former Employer 8: Company Name / Address / Phone

Former Employer 8: Supervisor Name

Former Employer 8: Dates of Service

Wages:

Paid:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #9:

Former Employer 9: Company Name / Address / Phone

Former Employer 9: Supervisor Name

Former Employer 9: Dates of Service

Wages:

Paid:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #10:

Former Employer 10: Company Name / Address / Phone

Former Employer 10: Supervisor Name

Former Employer 10: Dates of Service

Wages:

Paid:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #11:

Former Employer 11: Company Name / Address / Phone

Former Employer 11: Supervisor Name

Former Employer 11: Dates of Service

Wages:

Paid:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #12:

Former Employer 12: Company Name / Address / Phone

Former Employer 12: Supervisor Name

Former Employer 12: Dates of Service

Wages:

Paid:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #13:

Former Employer 13: Company Name / Address / Phone

Former Employer 13: Supervisor Name

Former Employer 13: Dates of Service

Wages:

Paid:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #14:

Former Employer 14: Company Name / Address / Phone

Former Employer 14: Supervisor Name (copy)

Former Employer 14: Supervisor Name

Former Employer 14: Dates of Service

Wages:

Paid:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

Former Employer #15:

Former Employer 15: Company Name / Address / Phone

Former Employer 15: Supervisor Name

Former Employer 15: Dates of Service

Wages:

Paid:

Hourly
Weekly
Yearly

Left because:

Quit
Laid off
Discharged
Other

First

Last

Name

Department of Motor Vehicle Release Date of Birth: *

Date of Birth:

Department of Motor Vehicle Release Driver's License Number: *

Driver's License Number:

Name

Notice of Required Drug Testing etc. Social Security Number

Social Security Number

Date

Name