APPLICATION FOR EMPLOYMENT

Company Name TRANSPORTATION COMMODITIES, INC

Address
City, State, Zip Code

Applicant: Read and sign before submitting this application.

I understand that the information in this application will be used and that prior employers will be contacted for purposes of
investigation as required by Section 391.23 of the Federal Carrier Safety Regulations.

09/20/2024
Signature of Applicant Date

Name Phone: ( )
First Middle Last

*Current Address
Street City State Zip Code

*If at the above residence less than three years, list below all residences for the past three years. Attach a separate sheet if necessary.

Street City State Zip Code

Street City State Zip Code

Date of Birth (Answer only if applying for driving position) Social Security No.:
MM/DD/YY

IN CASE OF EMERGENCY NOTIFY: Phone:

Address City State Zip Code

Position applying for: Temporary Part Time Full Time

Who referred you? Rate if pay expected?

Have you worked for this company before? Dates: From To

MM/DD/YY MM/DD/YY

Where? Rate of Pay Position

Reason for leaving

Names of any relatives employed by this company

Are you currently employed? If not, how long since leaving last employment?

GENERAL
Have you ever been bonded? Name of bonding company

Have you ever been convicted of a felony? If yes, please explain fully on a separate sheet of paper. Conviction
of a crime is not an automatic bar to employment - all circumstances will be considered.

Have you ever worked for this company under another name? Yes No If so, under what name?

EDUCATION
Circle highest grade completed: 1 2 3 4 5 6 7 8 9 10 11 12 College: 1 2 3 4
Last school attended:
Name Address
 MAINTENANCE EXPERIENCE & QUALIFICATIONS

List courses & training in maintenance work

Job function
Indicate training & Formal Training Years of Formal Training Years of
Area
experience in the following: (Check) Experience (Check) Experience
Drive Line Components Body Work
Diesel Engine Tune-up & Electrical Repair
Rebuild Frame & Wheel
Gas Engine Tune-up & Alignment
Rebuild Brakes
Tire Service Cooling System
Trailer Repair Inspections
Air Conditioning General Car Repair

Shop Equipment
Indicate training & Formal Training Years of Formal Training Years of
Area
experience in the following: (Check) Experience (Check) Experience
Electrical Diagnostic Equipment Wheel & Tire
Balancing Machine
Sheet Metal Equipment Tire Recapping Mold
Frame & Axle Straightening Equip Engine Dynamometer
Chassis Dynamometer
Engine Rebuilding Equipment Magnetic Crack Detector
Engine Analyzer
Diesel Injection Equipment Noise Measuring
Electric Welder Equipment
Oxyacetylene Welder Smoke Measuring
Paint Spray Gun Equipment
Air Conditioning Inspections
Tire Servicing Machine General Car Repair

CLERICAL EXPERIENCE & QUALIFICATIONS

List courses & training in maintenance work

Indicate training & Formal Training Years of Formal Training Years of

Area
experience in the following: (Check) Experience (Check) Experience
Typing (wpm) Photocopier
Shorthand (wpm) Switchboard Equip.
Billing (Indicate type)
Filing Tabulator
Computers (indicate software) Accounting
Word Processing Equipment OS & D
Key Punch Interline
Calculator Claims
Adding Machine Cashier
Telecopier Dispatcher

Rates (Indicate tariffs with which you have worked)

 EMPLOYMENT RECORD

The U.S. Department of Transportation requires that driver applicants show all employment for the past three years. Effective July, 1987, they
must also show commercial driver employment for the seven years immediately preceding this three-year period. 391.21 (b) (10), (11)

Start with last or current position, including military experience, and work back. (Attach a separate sheet of paper if necessary.)

Current Employer: Supervisor's Name:

Address: Phone: ( )
Position Held: From: To: Salary:
MM/YY MM/YY

Reason for Leaving:

Current Employer: Supervisor's Name:
Address: Phone: ( )
Position Held: From: To: Salary:
MM/YY MM/YY

Reason for Leaving:

Current Employer: Supervisor's Name:
Address: Phone: ( )
Position Held: From: To: Salary:
MM/YY MM/YY

Reason for Leaving:

DRIVER EXPERIENCE & QUALIFICATIONS
Licenses
State License No. Type Expiration Date
Driver licenses held
in past three years
must be shown
A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No
B. Has any license, permit or privilege ever been suspended or revoked? Yes No
C. Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations? Yes No
If you answered "yes" to A, B or C attach a statement giving details.
Driving Experience
Type of Equipment Dates Approximate
Class of Equipment (Vans, Tank, Flat, etc.) From To Total Miles
Straight Truck
Tractor & Semi-Trailer
Twin Trailers
Other
List states operated in during last five years:

List special courses or training that will help you as a driver:

List safe driving awards and who awards were presented by:
Accident Review for past three years (Attach a separate sheet of paper if more space is needed)
Nature of Accident Fatalities Injuries
Dates (Head-On, Rear-End, Upset, etc.)
Last Accident
Next Previous
Next Previous
Traffic Convictions and Forfeitures for the past three years other than parking violations
Location Date Charge Penalty
 PLATFORM EXPERIENCE & QUALIFICATION
List types of platform experience and number of years of each

List platform equipment you can operate (lift truck, etc.)

List courses or training in platform work

APPLICANT MUST READ & SIGN

It is agreed and understood that the employer or his agents may investigate the applicant's background to ascertain any and all information of
concern to applicant's record, whether same is of or not and applicant releases employers and persons named herein from all liability for any
damages on account of furnishing such information.
It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include
an investigative Consumer Report, including information regarding my character, general reputation, personal characteristics and mode of living.
I agree to furnish such additional information and complete such examinations as me be required to complete my employment file.
(GA & KS) - I understand that, as a condition of employment, I will obtain from the State Motor Vehicle Agency, within my probationary period,
and without cost to the employer, a copy of my motor vehicle violations record.
(MA) - "An applicant for employment with a sealed record on file with the commissioner of probation may answer "no record" with respect to
an inquiry herein relative to prior arrests, criminal court appearances or convictions. An applicant for employment with a sealed record on file
with the commissioners of probation may answer "no record" with respect to any inquiry relative to prior arrests, court appearances, and
adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court
for criminal prosecution."
(MD) - "AN EMPLOYER MAY NOT REQUIRE OR DEMAND ANY APPLICANT FOR EMPLOYMENT OR PROSPECTIVE EMPLOYMENT OR ANY
EMPLOYEE TO SUBMIT TO OR TAKE A POLYGRAPH, LIE DETECTOR OR SIMILAR TEST OR EXAMINATION AS A CONDITION OF EMPLOYMENT
OR CONTINUED EMPLOYMENT. ANY EMPLOYER WHO VIOLATES THIS PROVISION IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A
FINE NOT TO EXCEED $100.) Signature ____________________________________________________________
(PA) - I authorize my employer to obtain from the Registry of Motor Vehicles a copy of my Motor Vehicle Violations Records.
I understand that this application is not an employment contract and that, if hired my employment and compensation can be terminated, with or
without cause at any time at the option of either the company or myself.
This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my
knowledge.

Date Applicant's Signature

DO NOT WRITE IN THIS SPACE - FOR OFFICE USE - PROCESS RECORD

Applicant hired? Yes No

Date Employed Point Employed

Department Classification
(If not hired, summary report of reasons should be placed in file)

THIS SECTION TO BE FILLED IN BY RESPONSIBLE OFFICER OR COMPANY REPRESENTATIVE

Superior Good Fair Below Average Poor Written Record on File
1 Application
2 Interview
3 Physical Exam
4 Past Employment
5 Written Exam
6 Road Test
7 Policy & Traffic Record

Signature of Interviewing Officer Date

TRANSFERS
From: To: From: To:
Date: Date:
Reason for Transfer: Reason for Transfer:

TERMINATION OF EMPLOYMENT
Date Terminated: Department Released From:
Dismissed Voluntarily Quit Other
Termination Report Place in File Supervisor