General Application Page

PERSONAL INFORMATION

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email *

Upload a Resume (optional)

Position Applied For

Referred By

Desired Employment

Full Time
Part Time

Desired Pay

Date Available For Work

Have you applied for a position with the Company before?

If yes, when?

Have you previously been employed by the Company?

If yes, when?

What days are you available to work?

Days
Nights
Weekends
Overtime

How did you learn of the position?

If you are related to anyone employed by the Company, please state his or her name(s):

BACKGROUND DATA

Can you provide documentation to verify your identify and legal authority to work in the United States? (Proof of identify and legal authority to work will be required upon employment.)

Are you 18 years of age or older? (If no, you may be required to provide authorization to work.) *

If the job you are applying for requires you to operate a vehicle for Company purposes, do yo have a valid driver's license?

SBS Group of Companies must comply with Customs Regulations, as such, according to Section 111, SBS cannot knowingly employ any person convicted of a felony offense. If offered employment, the offer will be contingent upon completion of a background check and the results of that check. A Federal Fair Credit Reporting Act notice will be provided when you complete a release.

EDUCATION AND TRAINING

Select Highest Level of Education Achieved *

Name and Address of School

Subject of Major

Graduated

Degree

List other skills, experiences, training or other courses or qualifications which you feel may be helpful in evaluating your qualifications for employment: (Omit any which reflects your race, color, national origin, religion, age, sex, sexual orientation, marital status or disabilities.)

Do you belong to any professional, trade, business or civic organizations that deal with the position for which you are applying? (Omit any organization which reflects your race, color, national origin, religion, age, sex, sexual orientation, marital status or disabilities.)

If you are an experienced operator of any software, office or computer equipment, please list:

PREVIOUS EMPLOYMENT

Please list previous employers and military service, beginning with the most recent. If you list any employment prior to 5 years from today, list the total number of years and months you were consecutively employed by each employer (e.g., 2 years, 5 months). Please indicate what name you used during all periods of employment if different than your present name. Please provide all requested information and do not write "See Resume".

Name of Employer *

Address of Employer

Address Line 1

Address Line 2

City

State

Zip Code

Phone No.:

Responsibilities & Reason for leaving

May we Contact?

If you were self-employed or unemployed for more than three consecutive months at any time during the past five years, please indicate the dates and provide an explanation below:

PERSONAL REFERENCES

Please give name, address, and telephone number of three business references who are not related to you, know your employment qualifications and can provide professional and/or character references:

1.) List Name, Address, Phone Number, E-Mail Address, # of Years Known

2.) List Name, Address, Phone Number, E-Mail Address, # of Years Known

3.) List Name, Address, Phone Number, E-Mail Address, # of Years Known

PLEASE READ CAREFULLY BEFORE SIGNING

I certify that the answers given herein and during the hiring process are true, accurate and complete to the best of my knowledge. I understand and acknowledge that the falsification, misrepresentation or omission of fact(s) on this application (or any other accompanying or required documents) or during the hiring process may be cause for denial of employment or immediate termination of employment, regardless of when or how discovered, and I agree that the Company shall not be held liable as a result of such failure to hire or terminate. Questions regarding this statement should be directed to any employment interviewer before signing.

I hereby authorize the Company, and its employees, representatives, agents and vendors to make any investigation of the information contained in this application and of my background deemed necessary. I authorize any and all schools, former employers, referenes, courts and any others who have information about me to provide such information to the Company and/or any of its employees, representatives, agents or vendors, and I release the parties involved from any and all liability and any damages that may result from providing such information. I hereby release the Company and its employees, representatives, agents and vendors from any and all liability of whatever kind of nature for seeking information and opinions on me and if an employment decision is based on the result of obtaining and/or having such information.

I understand the receipt or submission of this application does not guarantee employment with the Company and that nothing contained in this employment application or in the granting of an interview, and no Company policies, procedures or handbooks that I might receive if I am hired are intended to create an employment contract between the Company and me for either employment or the providing of any benefit. No binding on the Company unless made in writing and signed by an authorized Officer of the Company. If hired, I agree to abide by all Company rules, regulations, policies and procedures. I further understand that if employed, my employment is at-will and may be terminated with or without cause, and with or without notice, at any time, at the option of either the Company or me.

BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND AND AGREE TO THE ABOVE STATEMENT.

Name *

First

Last

EE0-1 Self-Identification Form

Responses are used to complete the Department of Labor EEO Reporting.

The employer is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. To comply with these laws, the employer invites employees to voluntarily self identify their race and ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.

Thank you for your participation!

Name *

Gender:

Male
Female
Prefer Not to Answer

Job Title:

VETERAN STATUS: Vets-100

I am NOT a Veteran
YES, I am a Veteran

*Please complete the VETs-100 form

DISABILITY: Do you have a disability?

Yes
No
Prefer Not to Answer

If you checked "Yes", is your disability one of the targeted disabilities listed below?

Yes
No
Prefer Not to Answer

- Blind - Deaf - Missing Extremity (s) - Convulsive Disorder - Mental Retardation - Mental Illness - Partial Paralysis - Complete Paralysis - Genetic or physical condition affecting limbs or spine

Veteran Self-Identification Form 100

Responses are used to complete the required VETS-100 Reporting

Name *

Date / Time

Are you a veteran?

If Yes, what is your Date of Discharge

If you are a Veteran, please continue and check all that apply (see below for definitions)

Are you retired from the military?

If Yes, what is your Date of Retirement

Are you a Disabled Veteran?

Are you a Veteran of the Vietnam era?

Other protected Veteran

(Veteran who served on active duty in the U.S. military during a war or in a campaign or expedition for which a campaign badge is awarded)

Recently separated Veteran

(Veteran within 12 months from discharge or release from active duty)

Do you qualify for Veteran's Preference?

(The last war for which active duty is qualifying for Veterans preference is World War II (12-4-41 thru 4-28-52))

If yes, please explain:

The U.S. Department of Labor (DOL). Veterans' Employment and Training Service (VETS) annually collects and compiles the Federal Contractor Veterans' Employment Report (VETS-100) from federal contractors and subcontractors. DEL REY is an Equal Opportunity Employer and ensures its personnel processes provide for careful, thorough and systematic consideration of the job qualifications of applicants and employees with known disabilities and for covered Veterans for job vacancies filled. DEL REY takes affirmative action to employ, advance in employment, and otherwise treat qualified individuals without discrimination based on their status as individuals with disabilities and/or Covered Veterans in all employment practices. Under the regulations implementing the affirmative action provisions of VEVRAA issued by the Office of Federal Contract Compliance Programs (OFCCP), a federal contractor is required to invite applicants and current employees to inform the contractor whether he or she is a Veteran belonging to one or more of the categories of Veterans covered under VEVRAA who wishes to benefit under the contractor's affirmative action program (AAP) for covered Veterans. Definitions follow:

Disabled Veteran means:

1. A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans' Affairs for a disability.
(A) rated at 30 percent or more, or
(B) rated at 10 or 20 percent in the case of a Veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap

2. A person who was discharged or released from active duty because of a service-connected disability.

Veteran of the Vietnam era means:

A person who:

1. Served on active duty in the U.S. military, ground naval or air service for a period of more than 180days and who was discharged or released with other than a dishonorable discharge, if any part of such active duty was performed:
(A) In the Republic of Vietnam between February 28, 1961, and May 7, 1975, or
(B) Between August 5, 1964, and May 7, 1975, in all other cases.

2. Was discharged or released from active duty in the U.S. miltary, ground, naval or air service for a service-connected disability if any part of such active duty was performed:
(A) In the Republic of Vietnam between February 28, 1961, and May 7, 1975; or
(B) Between August 5, 1964, and May 7, 1975, in any other location.

Other protected Veteran means:

Veterans who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the U.S. Department of Defense.

Recently separated Veteran means:

Any Veteran during the three-year period beginning on the date of such Veteran's discharge or release from active duty in the U.S. military, ground, naval or air service.

Armed Forces Service Medal Veteran means:

Any Veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation to which an Armed Forces Service Medal was awarded pursuant to Executive Order 12985.

Minimum Driver Qualification Information

Company Name *

Address *

City *

State *

The purpose of this document is to determine whether or not the driver is qualified to operate motor carrier equipment according to the requirements of the Federal Motor Carrier Safety Regulations and the Company named above.

Instructions to Driver

Please answer all questions. If the answer to any question is "No" or "None", do not leave the item blank, but write "No" or "None"

Name *

First

Last

Drivers License Number *

Position applying for; (Choose One) *

Contractor
Driver
Contractor's Driver

Phone Number

Are you 23 years of age or older?

Date of Birth

Physical Exam Expiration Date

Current & Three Years Previous Addresses

First

Middle

Last

Current & Three Years Previous Addresses # 2

First

Middle

Last

Current & Three Years Previous Addresses # 3

First

Middle

Last

Have you worked for this company before? *

Education History

Please select the highest grade completed for the following education types.

Grade School (Select "None" if necessary)

College (Select "None" if necessary)

Employment History

Give a Complete Record of all employment for the past three years, including any unemployment or self employment, and all commercial driving experience for the past ten years.

Past Employment # 1

First

Middle

Last

Position Held # 1

First

Last

Reason For Leaving # 1

First

Last

Were you subject to the FMCSRs* while employed here?

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?

Past Employment # 2

First

Middle

Last

Position Held # 2

First

Last

Reason For Leaving # 2

First

Last

Were you subject to the FMCSRs* while employed here?

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?

Past Employment # 3

First

Middle

Last

Position Held # 3

First

Last

Reason For Leaving # 3

First

Last

Were you subject to the FMCSRs* while employed here?

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?

Past Employment # 4

First

Middle

Last

Position Held # 4

First

Last

Reason For Leaving # 4

First

Last

Were you subject to the FMCSRs* while employed here?

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?

Past Employment # 5

First

Middle

Last

Position Held # 5

First

Last

Reason For Leaving # 5

First

Last

Were you subject to the FMCSRs* while employed here?

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?

Disclaimer

The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone who operates a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) has a GVWR or weighs 10,001 pounds or more, (2) is designed or used to transport nine or more passengers, or (3) is of any size, used to transport hazardous materials in a quantity requiring placarding.

Driving Experience

Class of Equipment

List of States Operated in # 1

List states operated in, for the last five years:

List special courses/training completed # 1

List Special courses/training completed (PTD/DDC, Haz Mat, etc.):

List any Safe Driving Awards you hold and from whom # 1

List any Safe Driving Awards you hold and from whom:

Accident Report for past three years

For accidents from the past three years, please list the following: Date of Accident, Nature of Accident (Head on, rear end, upset, etc.), Location of Accident, # of Fatalities, and # of People Injured

Traffic Convictions and Forfeitures for the last three years (other than parking violations)

For Traffic Convictions and Forfeitures, please list the following: Date of Conviction, Location, Charge, and the Penalty

Driver's License

List each driver's license held in the past three years, including: State, Type, Endorsements, and Expiration Date

A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle? *

B. Has any license, permit, or privilege ever been suspended or revoked? *

C. Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)? *

D. Have you ever been convicted of a felony? *

Driver Applicant Drug and Alcohol Pre-Employment Statement

CFR Part 40.25 (j) requires the employer to ask any driver applicant, whether he or she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol rules during the past two years. If the potential employee admits that he or she had a positive test or refusal to test, employers must not use the employee, if hired, to perform safety-sensitive functions, until and unless the potential employee provides documentation of successful completion of the return-to-duty process. (See CFR 40.25(b)(5) and (e)).

Applicant Name *

First

Last

SSI #

Phone #

Since you are applying to perform safety-sensitive functions for our company, we are required by CFR Part 40.25(j), to ask the following questions:

Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?

SBS Group of Companies does not provide legal advice to its customers, nor does it advise insureds on employment related issues, therefore the subject matter is not intended to serve as legal or employment advice for any issue(s) that may arise in the operations of its insureds. Legal advice should always be sought from the insured's legal counsel. SBS Group of Companies shall have neither liability nor responsibility to any person or entity with respect to any loss, action or inaction alleged to be caused directly or indirectly as a result of the information contained herein.

Controlled Substance & Alcohol Testing Information Acknowledgement/Consent Form

As a condition of employment with (Enter Motor Carrier)...

commercial motor vehicle (CMV) driver applicants, who will perform safety-sensitive functions, must submit to a pre-employment controlled substances test as required by the Federal Motor Carrier Safety Regulations (FMCSR) Section 382.301. A motor carrier must receive verified negative test results for the applicant driver for the applicant to be eligible for employment.

If you are hired, you will be subject to laws requiring additional controlled substances and alcohol testing on you under numerous situations including, but not limited to, the following:

A driver who tests positive for a controlled substance(s) and/or alcohol test, will be immediately removed from a safety-sensitive position as required by Part 382 of the FMCSR. Federal law prohibits a driver from returning to a safety-sensitive position for any motor carrier until and unless the driver completes the Substance Abuse Professionals (SAP) evaluation, referral and educational/treatment process, as described in FMCSR Part 40, Subpart O.

Employment Application

Please fill out this form in its entirety

PERSONAL INFORMATION

BACKGROUND DATA

EDUCATION AND TRAINING

PREVIOUS EMPLOYMENT

PERSONAL REFERENCES

PLEASE READ CAREFULLY BEFORE SIGNING

BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND AND AGREE TO THE ABOVE STATEMENT.

EE0-1 Self-Identification Form

Veteran Self-Identification Form 100

Trucker Application Form

Minimum Driver Qualification Information

Instructions to Driver

Education History

Employment History

Disclaimer

Driving Experience

Accident Report for past three years

Traffic Convictions and Forfeitures for the last three years (other than parking violations)

Driver's License

Driver Applicant Drug and Alcohol Pre-Employment Statement

Controlled Substance & Alcohol Testing Information Acknowledgement/Consent Form

If you are hired, you will be subject to laws requiring additional controlled substances and alcohol testing on you under numerous situations including, but not limited to, the following:

Disclaimer

Employment Application

Please fill out this form in its entirety

PERSONAL INFORMATION

BACKGROUND DATA

EDUCATION AND TRAINING

PREVIOUS EMPLOYMENT

PERSONAL REFERENCES

*PLEASE READ CAREFULLY BEFORE SIGNING*

BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND AND AGREE TO THE ABOVE STATEMENT.

EE0-1 Self-Identification Form

Veteran Self-Identification Form 100

PLEASE READ CAREFULLY BEFORE SIGNING