Online Employment Application [step s="1" title="General Information"] General Information Full Legal Name Address Address 2 City StateSelect StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zipcode Phone Number Alternate Phone Number Email Address Position & Work Related Information Are you eligible to work in the USA?---YesNo Are you at least 18 years of age?---YesNo Please Select Amount of Experience in Related Field---Less than 1 year1-5 years6-10 years10+ years Expected Rate of Pay (Hourly or Aunnual) Date Available to Start Working How did you hear about Logisticize, LLC?---EmployeeNewspaper AdLinkedInZip RecruiterTemp AgencyOther Have you ever worked for Logisticize, LLC?---YesNo Criminal History Have you ever been convicted for something other than minor traffic violation?:---NoYes - Please Explain Below What Date Were You Convicted? City of Conviction StateSelect StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Type of Conviction Additional Conviction Comments [nextbutton] [/step] [step s="2" title="Previous Employment"] 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?YesNo 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?YesNo 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?YesNo [backbutton] [nextbutton] [/step] [step s="3" title="Driving Record & License Information"] Driving Record & License Information EndorsementsDouble 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?NoYes - Please Explain Below Additional Comments Collisions Date Collision Details StateSelect StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Number of Injuries012345678910+ Number of Fatalities012345678910+ Hazardous Material SpillNoYes Collisions Date Collision Details StateSelect StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Number of Injuries012345678910+ Number of Fatalities012345678910+ Hazardous Material SpillNoYes Collisions Date Collision Details StateSelect StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Number of Injuries012345678910+ Number of Fatalities012345678910+ Hazardous Material SpillNoYes Traffic Convictions & Forfeitures Date StateSelect StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Violation Penalty Commercial VehicleNoYes Traffic Convictions & Forfeitures Date StateSelect StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Violation Penalty Commercial VehicleNoYes Traffic Convictions & Forfeitures Date StateSelect StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Violation Penalty Commercial VehicleNoYes Driving Experience Straight Truck---VanTankFlatOther Date: to Approximate Miles Driven Tractor & Semi Trailer---VanTankFlatOther Date: to Approximate Miles Driven Other---VanTankFlatOther Date: to Approximate Miles Driven List Commodities Hauled [backbutton] [nextbutton] [/step] [step s="4" title="Education"] Education (Most Recent First) Name of School Diploma/Degree CompletionYesNoIn Progress Achievements, Awards, Volunteering, and/or Comments Education Name of School Diploma/Degree CompletionYesNoIn Progress Achievements, Awards, Volunteering, and/or Comments Education Name of School Diploma/Degree CompletionYesNoIn Progress Achievements, Awards, Volunteering, and/or Comments [backbutton] [nextbutton] [/step] [step s="5" title="Military Information"] Military Information Military BranchSelect Military BranchUnited States ArmyUnited States NavyUnited States AirforceUnited States Marine CorpsCoast GuardNational GuardAir National Guard Specialty Rank Time Served Discharge Date Achievements, Awards, Volunteering, and/or Comments [backbutton] [nextbutton] [/step] [step s="6" title="Questionnaire"] Questionnaire Why Do You Want To Work For Logisticize, LLC? Additional Comments Do you have relatives working for Logisticize, LLC?NoYes - Please List Relatives Below 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 [backbutton] [nextbutton] [/step] [step s="7" title="Reference"] Reference Full Name Title Company Address Address 2 City StateSelect StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zipcode Phone Number Relationship to ReferenceRelationship TypePersonalProfessionalBoth Reference Full Name Title Company Address Address 2 City StateSelect StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zipcode Phone Number Relationship to ReferenceRelationship TypePersonalProfessionalBoth [backbutton] [nextbutton] [/step] [step s="8" title="Review"] 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 person listed have my permission to give out lawful information concerning me, and are released from all liability on my part. Attach Resume (.doc,.docx, or .pdf) [backbutton] [/step]