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McFarland Trucking

P.O. Box 303

Calpella, CA  95418

Application for Employment

Notice: Completion of this application and acceptance of employment could subject you to our pre-employment physical and drug screen.

We are on equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, disability or national origin.  Consistent with the Americans with Disabilities Act, applicants may request accommodations needed to participate in the application process.

 Personal Information

Name :     Last          First                   Middle initial

Address      City      State          Zipcode

Phone Number    Emergency name and phone number

Date of birth (xx/xx/xxxx)                                 Social Security No

Date of last physical                              Doctor’s Name

List any physical limitations (diabetes, heart disease, eye sight, limb impairment, etc)

Experience & Qualifications

Job applied for                            Years experience

Type of equipment & length of time previously operated

Have you ever been denied a Permit, License, or Privilege to operate a motor vehicle?

Has you Permit, License, or Privilege been suspended or revoked: Explain

Have you ever been convicted of driving under the influence of alcohol or drugs?

Have you ever been convicted of a crime? Explain:

Do you have a valid drivers license?                  License number            type     

expiration date

Accident & Traffic convictions last three years

Date     Nature of accident        fatalities            injuries              commercial or personal vehicle

Employment History (this portion must be completed)

Last employer Name:                Phone  

  Address                                                        city          state        zip 

From   mo  day  year                To mo day year                        Position:

Reason for leaving

Last employer Name:                Phone  

  Address                                                       city          state          zip 

From   mo  day  year                To mo day year                        Position:

Reason for leaving

Last employer Name:                Phone  

  Address                                                       city          state          zip 

From   mo  day  year                To mo day year                        Position:

Reason for leaving

Last employer Name:                Phone  

  Address                                                       city          state          zip 

From   mo  day  year                To mo day year                        Position:

Reason for leaving

Any Comments, etc?

I hereby do agree to have my former employers contacted to verify said information.  I also swear that all the information on my application is true.  I understand that any falsification or omission of information can lead to refusal to hire or if hired, termination of employment could result.  I understand that employment is at-will and be ended at any time for any reason.

Name:

Date