Employment Application

Applicant Information

Last Name *

First Name *

Date *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Phone Number *0 / 14

Email Address *

Date of Birth *

Date Available *

Time at Residence *

Desired Salary

Select *

Social Security Number *0 / 11

Hidden *

Have you ever worked for Petroleum Carriers before? *YesNo

Who referred you?

When? *

Are you a citizen of the United States? *YesNo

Have you ever been convicted of a felony? *YesNo

Are you authorized to work in the United States? *YesNo

Please explain: *

Please note: Answering "Yes" to any of the following questions will not necessarily disqualify you from employment.

Have you ever been denied a license, permit, or the privilege to operate a motor vehicle? *YesNo

Have you tested positive for drugs or alcohol in the past 3 years? *YesNo

Has any license, permit or privilege ever been suspended or revoked? *YesNo

Have you refused to take a test for drugs or alcohol in the past 3 years? *YesNo

Education

High School

Address

From

To

Did you graduate?YesNo

Degree

College

Address

From

To

Did you graduate?YesNo

Degree

Other

Address

From

To

Did you graduate?YesNo

Degree

Previous Employment

Do you have previous work experience? *YesNo

Company *

City, State, Zip *

Phone *0 / 14

Supervisor

Job Title *

Starting Salary

USD

Ending Salary

USD

Responsibilities

From *

To *

Reason for leaving *

May we contact this employer for a reference?YesNo

Add another previous employer? *YesNo

Company *

City, State, Zip *

Phone *0 / 14

Supervisor

Job Title *

Starting Salary

USD

Ending Salary

USD

Responsibilities

From *

To *

Reason for leaving *

May we contact this employer for a reference?YesNo

Add another previous employer? *YesNo

Company *

City, State, Zip *

Phone *0 / 14

Supervisor

Job Title *

Starting Salary

USD

Ending Salary

USD

Responsibilities

From *

To *

Reason for leaving *

May we contact this employer for a reference?YesNo

Add another previous employer? *YesNo

Company *

City, State, Zip *

Phone *0 / 14

Supervisor

Job Title *

Starting Salary

USD

Ending Salary

USD

Responsibilities

From *

To *

Reason for leaving *

May we contact this employer for a reference?YesNo

Add another previous employer? *YesNo

Company *

City, State, Zip *

Phone *0 / 14

Supervisor

Job Title *

Starting Salary

USD

Ending Salary

USD

Responsibilities

From *

To *

Reason for leaving *

May we contact this employer for a reference?YesNo

Additional previous employment information may be uploaded at the end of the application, if desired.

Military service

Hve you ever served in the United States Armed Forces? *YesNo

Branch *

From *

To *

Rank at discharge *

Type of discharge *

If other than honorable, please explain:

Driving Record

Have you had any traffic convictions or forfeitures, other than parking violations, within the past 3 years? *YesNo

Traffic convictions and forfeitures for the past 3 years. Do not include parking violations.

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Experience and Qualifications

Licenses

State *

License Number *

Type (A,B,C) *

Expiration Date *

State

License Number

Type (A,B,C)

Expiration Date

State

License Number

Type (A,B,C)

Expiration Date

Class of Equipment

Straight Truck *YesNo

Year Began *

Year End *

Miles Driven

Tractor-Trailer *YesNo

Year Began *

Year End *

Miles Driven

Tractor-Double Trailers *YesNo

Year Began *

Year End *

Miles Driven

Tractor-Tank Trailer *YesNo

Year Began *

Year End *

Miles Driven

Tractor-Flat Trailer *YesNo

Year Began *

Year End *

Miles Driven

Do you have any experience operating a manual transmission? *YesNo

Please give the extent of your experience:

Accident record for the past 3 years, minimum.

Date

Nature of Accident (rear-end, roll-over, head-on, etc.)

Deaths?YesNo

Injuries?YesNo

Date

Nature of Accident (rear-end, roll-over, head-on, etc.)

Deaths?YesNo

Injuries?YesNo

Date

Nature of Accident (rear-end, roll-over, head-on, etc.)

Deaths?YesNo

Injuries?YesNo

Additional Information

Upload Additional Information

Resume, Cover Letter, Additional Information, etc.

AUTHORIZATION FOR CONSUMER AND /OR INVESTIGATIVE REPORT

I acknowledge that, as a condition of employment or continued employment, Petroleum Carriers LLC ("Company") may, now or any time during my employment with Company, obtain a consumer report about me, as applicable and to the extent permitted by law. The consumer report may include verification of my education, previous employment/work history, credit history, motor vehicle records, verification from personal references, drug testing, criminal history located in the files of any Federal, State, or Local criminal justice agency, and verification of any other information deemed necessary by Company. The results of this consumer report will be used to determine employment eligibility under Company's employment policies. I acknowledge that if information from the report is used in whole or in part in taking adverse action with regard to my potential or continued employment, before taking the adverse action, Company will provide me with a copy of the consumer report and a copy of "A Summary of Your Rights Under the Fair Credit Reporting Act."

I authorize AccuSourceHR, Inc., a third-party consumer reporting agency, and any of its agents, to disclose orally and in writing the results of the consumer report to the designated authorized representative of Company. AccuSourceHR, Inc. is located at 11811 N. Tatum Blvd., Suite 3031, Phoenix, AZ 85028, has a phone number of951-734-8882 or toll-free 888-649-6272, email ofcs@accusourcehr.com, and website of www.accusourcehr.com.

I authorize persons, schools, current and former employers, and other organizations and agencies to provide AccuSourceHR, Inc. with all information that may be requested. I agree that any copy of this document is as valid as the original. According to the Federal Fair Credit Reporting Act, I am entitled to know if employment was denied based on information obtained by my prospective employer and to receive a disclosure of the public record information and of the nature and scope of the investigative report.

Disclaimer and Signature

Signature *

Date *

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Applicant Information