Transport

Careers

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.

List additional addresses of residency for the past three (3) years
Have you been discharged, terminated or suspended from any position you have held?
yesno
Have you ever been convicted of a felony?
yesno
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?
yesno
Have you been convicted of driving under the influence of alcohol, narcotic drugs, amphetamines or derivatives there of during the past (5) years
yesno
Are you a U.S. citizen?
yesno
if no, do you have a legal right to remain in the U.S?
yesno
Do you have a current legal work permit?
yesno
EMERGENCY CONTACT INFORMATION:
Have you worked for this company before
yesno
Dates

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.

Dates
Were you subject to the Federal Motor Carrier Safety Regulations while employed here
yesno
Was employment designated as a “safety sensitive function”in regard to drug/alcohol testing requiredby 49CFR Part 40
yesno
Dates
Were you subject to the Federal Motor Carrier Safety Regulations while employed here
yesno
Was employment designated as a “safety sensitive function”in regard to drug/alcohol testing requiredby 49CFR Part 40
yesno
Dates
Were you subject to the Federal Motor Carrier Safety Regulations while employed here
yesno
Was employment designated as a “safety sensitive function”in regard to drug/alcohol testing requiredby 49CFR Part 40
yesno

ACCIDENT RECORD FOR PAST 3 YEARS - List ALL, whether Preventable or Non-Preventable

if not please blank fields

ACCIDENT


DATE NATURE OF ACCIDENT


FATALITIES


INJURIES


VEHICLES TOWED


ALL TRAFFIC CONVICTIONS & FORFEITURES FORTHE PAST 3 YEARS - Other than parking violation

if not please blank fields

LOCATION


DATE


CHARGE


PENAL


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

STATE


LICENSE #


CDL CLASS


ENDORSEMENTS


EXPIRATION


A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?
yesno
B. Has any license, permit or privilege ever been suspended or revoked
yesno

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


TYPE OF EQUIPMENT
(VAN, TANK FLAT,ETC)


DATES


APPROX NO.PPROX NO. OF MILES
(per year)


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

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