Your Career Interests: CompanyOwner/Operator Shop
First Name: Last name:
Address:
City: State: Zip Code
E-mail
Telephone:
Date of Birth: MonthDay 4 digit Year
Social Security Number: License Number:
License State: Class:  Expiration Date:
CDL?
Have you ever had a: DUI/DWI?If so, when?  MM/DD/YYYY
Misdemeanor or Felony

   If Yes Give all the details:

  If so, when? 

Number of Moving Violations in past 3 years?
Number of accidents in past 3 years?

Who Referred You?

Employment History: Present Employer

Present employer: May we contact?
Date of employment: From   to .
Telephone:
Address:
City: State:  Zip
Type of trailer?
Number of states:

Employment History: First Previous Employer

First previous employer:
Date of employment: From  To 
Telephone:
Address:
City: State:  Zip:
Type of trailer? Number of states:
Reason for leaving:

Employment History: Second Previous Employer

Second previous employer:
Date of employment: From To
Telephone:
Address:
City: State:  Zip: 
Type of trailer? Number of states:
Reason for leaving:

Employment History: Third Previous Employer

Third previous employer:
Date of employment: From  To
Telephone:
Address:
City: State:  Zip:
Type of trailer? Number of states:
Reason for leaving:
I certify that I personally completed this pre-application for the purpose of employment (including contract for services) and that all the information herein is true and correct. I agree that any falsification or omission of information, now or at any time, will result in my disqualification. I authorize Sharp Transport. to do a complete background investigation in accordance with federal and state laws. I authorize release of any information, including all information related to my alcohol and controlled substance testing and training records, by any former employers and hold them harmless of any liability from release of said information. I also consent to the procurement and use of any consumer reports, including reports from DAC Services, Inc., deemed necessary by Sharp Transport in consideration of my employment.  I understand that in accordance with FMCSR 391.23 (i)(2), (j)(1) and (j)(3), I have the right to review information provided by previous employers, the right to have errors in the information corrected by the previous employer, and for that previous employer to re-send the corrected information to the prospective employer and the right to have a rebuttal statement attached to the alleged erroneous information if the previous employer and I cannot agree on the accuracy of the information.  Signature Date (MM/DD/YYYY)