• (616) 243-4945
• armin@arkoexchange.com
• 3901 Eastern Avenue SE Suite B

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APPLICATION FOR EMPLOYMENT

Answer ALL questions or this application will not be processed – please print.

We are an Equal Opportunity Employer that does not discriminate in employment based on race, color, creed, age, sex, national origin, physical or mental handicap, ancestry, religion, marital status, sexual orientation, military service, or any other characteristic protected by law. Arko Exchange, LLC will endeavor to make a reasonable accommodation to the physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship to the operation of the business or not meet federal requirements as set by the FMCSA. If you require assistance to complete this form or to participate in an interview, please let us know.

Name *

First

Middle

Last

Your current address

Your Street

Your City

Your State

Your Zip

How long at current address?

Your e-mail address *

Social security no

Home phone / Cell phone

Date of birth

List additional addresses of residency for the past three (3) years

Your Street 1/3

Your City 1/3

Your State 1/3

Your Zip 1/3

Your Street 2/3

Your City 2/3

Your State 2/3

Your Zip 2/3

Your Street 3/3

Your City 3/3

Your State 3/3

Your Zip 3/3

Have you been discharged, terminated or suspended from any position you have held?

• Yes
• No

If yes, explain ...

Have you ever been convicted of a felony?

• Yes
• No

If yes, explain ...

Have you tested positive or refused to test on any DOT drug or alcohol test during the past five (5) years, including any Pre-employment test for any company to which you applied, but did not obtain work?

• Yes
• No

Have you been convicted of driving under the influence of alcohol, narcotic drugs, amphetamines or derivatives there of during the past (5) years

• Yes
• No

Are you a U.S. citizen?

• Yes
• No

Do you have a legal right to remain in the U.S?

• Yes
• No

Do you have a current legal work permit?

• Yes
• No

EMERGENCY CONTACT INFORMATION:

Name

Relationship

Current address

Your street

Your city

Your state

Your Zip

Phone number

Phone number

Have you worked for this company before

• Yes
• No

If yes, where ...

From date

To date

Who referred you

EMPLOYMENT HISTORY

List all employment (even non-driving positions), full and part time, for the past 3 years. Then, list all driving positions only that you held for the last 4 to 10 years as required by FMCSR Part 391. If you were leased to a motor carrier, list that carrier as an employer even if you were an independent contractor. Indicate any period of unemployment exceeding 30 days. Start with the most current or present position and work backwards.

From date

To date

Company

Phone number

Address

Supervisor

Position held

Trailer type

Reason for leaving

Were you subject to the Federal Motor Carrier Safety Regulations while employed here

• Yes
• No

Was employment designated as a “safety sensitive function”in regard to drug/alcohol testing requiredby 49CFR Part 40

• Yes
• No

From date

To date

Company

Phone number

Address

Supervisor

Position held

Trailer type

Reason for leaving

Were you subject to the Federal Motor Carrier Safety Regulations while employed here

• Yes
• No

Was employment designated as a “safety sensitive function”in regard to drug/alcohol testing requiredby 49CFR Part 40

• Yes
• No

ACCIDENT RECORD FOR PAST 3 YEARS - List ALL, whether Preventable or Non-Preventable (*if not please blank fields)

ACCIDENT

Accident

Accident

Accident

DATE NATURE OF ACCIDEN

DATE NATURE OF ACCIDENT

Date nature of accident

Date nature of accident

FATALITIES

YES OR NO

YES OR NO

YES OR NO

INJURIES

YES OR NO

YES OR NO

YES OR NO

VEHICLES TOWED

YES OR NO

YES OR NO

YES OR NO

ALL TRAFFIC CONVICTIONS & FORFEITURES FORTHE PAST 3 YEARS - Other than parking violation (*if not please blank fields)

LOCATION

LOCATION

LOCATION

LOCATION

DATE

DATE

DATE

DATE (copy)

CHARGE

CHARGE

CHARGE

CHARGE

PENAL

PENAL

PENAL

PENAL

DRIVERSLICENSEINFORMATION - List ALL licenses held in past five (3) years

STATE

STATE

STATE

STATE

LICENSE #

LICENSE #

LICENSE #

LICENSE #

CDL CLASS

CDL CLASS

CDL CLASS

CDL CLASS

ENDORSEMENTS

ENDORSEMENTS

ENDORSEMENTS

ENDORSEMENTS

EXPIRATION

EXPIRATION

EXPIRATION

EXPIRATION

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

IF THE ANSWER TO EITHER A OR B IS YES, ATTACH STATEMENT GIVING DETAILS. COMMERCIAL DRIVING EXPERIENCE (*if not please blank fields)

CLASS OF EQUIPMENT

Straight Truck

Tractor and semi-trailer

Tractor-two traile

TYPE OF EQUIPMENT (VAN, TANK FLAT,ETC)

Type of equipment

Type of equipment

Type of equipment

DATES

DATES

DATES

DATES

APPROX NO. OF MILES (per year)

APPROX NO. OF MILES (per year)

APPROX NO. OF MILES (per year)

APPROX NO. OF MILES (per year)

List all states operated in for last five years

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

Which safe driving awards do you hold and from whom

Agree *

• I understand that all employees of the Prospective Employer named in this application (Company) are employed on an indefinite basis and are subject to termination at any time, with or without notice, with or without prior discipline or warning, and with or without cause. 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 knowladge

Email *

Submit

About us

Arko Exchange LLC was founded in 2011, is family-owned, and delivers some of the most reliable logistics services in the Midwest.

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OFFICE

• 3901 Eastern Avenue SE Suite B, Wyoming, MI 49508
• (616) 243-4945
• armin@arkoexchange.com
• 616-243-4950
• Mon - Sat: 9:00 - 18:00

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