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    General Information


    Full Legal Name

    Address

    Address 2

    City

    State

    Zipcode

    Phone Number

    Alternate Phone Number

    Email Address






    Position & Work Related Information


    Are you eligible to work in the USA?

    Are you at least 18 years of age?

    Please Select Amount of Experience in Related Field

    Expected Rate of Pay (Hourly or Aunnual)

    Date Available to Start Working

    How did you hear about Logisticize, LLC?

    Have you ever worked for Logisticize, LLC?






    Criminal History


    Have you ever been convicted for something other than minor traffic violation?:

    What Date Were You Convicted?

    City of Conviction

    State

    Type of Conviction

    Additional Conviction Comments


    Previous Employment


    Name of Employer

    Your Job Title

    Your Duties

    Date Started

    Employed Until

    Pay Rate

    Reason For Leaving

    Supervisor's Name

    Supervisor's Number

    May We Contact This Employer?



    Previous Employment


    Name of Employer

    Your Job Title

    Your Duties

    Date Started

    Employed Until

    Pay Rate

    Reason For Leaving

    Supervisor's Name

    Supervisor's Number

    May We Contact This Employer?



    Previous Employment


    Name of Employer

    Your Job Title

    Your Duties

    Date Started

    Employed Until

    Pay Rate

    Reason For Leaving

    Supervisor's Name

    Supervisor's Number

    May We Contact This Employer?



    Driving Record & License Information


    Endorsements
    Double or Triple TrailersTank VehiclesPassenger VehiclesHazardous Materials

    Has your Permit, CDL, or privilege to operate a motor vehicle ever been denied, suspended, or revoked or cancelled?

    Additional Comments



    Collisions


    Date

    Collision Details

    State

    Number of Injuries

    Number of Fatalities

    Hazardous Material Spill



    Collisions


    Date

    Collision Details

    State

    Number of Injuries

    Number of Fatalities

    Hazardous Material Spill



    Collisions


    Date

    Collision Details

    State

    Number of Injuries

    Number of Fatalities

    Hazardous Material Spill



    Traffic Convictions & Forfeitures


    Date

    State

    Violation

    Penalty

    Commercial Vehicle



    Traffic Convictions & Forfeitures


    Date

    State

    Violation

    Penalty

    Commercial Vehicle



    Traffic Convictions & Forfeitures


    Date

    State

    Violation

    Penalty

    Commercial Vehicle



    Driving Experience


    Straight Truck

    Date:
    to

    Approximate Miles Driven



    Tractor & Semi Trailer

    Date:
    to

    Approximate Miles Driven



    Other

    Date:
    to

    Approximate Miles Driven



    List Commodities Hauled



    Education (Most Recent First)


    Name of School

    Diploma/Degree

    Completion

    Achievements, Awards, Volunteering, and/or Comments



    Education


    Name of School

    Diploma/Degree

    Completion

    Achievements, Awards, Volunteering, and/or Comments



    Education


    Name of School

    Diploma/Degree

    Completion

    Achievements, Awards, Volunteering, and/or Comments




    Military Information


    Military Branch

    Specialty

    Rank

    Time Served

    Discharge Date

    Achievements, Awards, Volunteering, and/or Comments




    Questionnaire


    Why Do You Want To Work For Logisticize, LLC?

    Additional Comments






    Do you have relatives working for Logisticize, LLC?

    Relative's Name

    Relative's Phone Number

    Relationship to Relative



    Relative's Name

    Relative's Phone Number

    Relationship to Relative



    Relative's Name

    Relative's Phone Number

    Relationship to Relative



    Reference


    Full Name

    Title

    Company

    Address

    Address 2

    City

    State

    Zipcode

    Phone Number

    Relationship to Reference



    Reference


    Full Name

    Title

    Company

    Address

    Address 2

    City

    State

    Zipcode

    Phone Number

    Relationship to Reference





    I hereby certify that all the information given is true and complete, and agree that any false information given during the hiring process, or after employment may be grounds for denial of employment or immediate discharge if employed.

    The companies, schools and people listed have my permission to give out lawful information concerning me, and are released from all liability on my part.






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