Employment Application Get Behind the Wheel of a Great Career Print Application Applicant Information Last Name *First Name *Date *Street Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *Phone Number *0 / 14Email Address *Date of Birth *Date Available *Time at Residence *Desired SalarySelect *Position Applying ForPetroleum Transport DriverSocial Security Number *0 / 11Hidden *Have you ever worked for Petroleum Carriers before? *YesNoWho referred you?When? *Are you a citizen of the United States? *YesNoHave you ever been convicted of a felony? *YesNoAre you authorized to work in the United States? *YesNoPlease 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? *YesNoHave you tested positive for drugs or alcohol in the past 3 years? *YesNoHas any license, permit or privilege ever been suspended or revoked? *YesNoHave you refused to take a test for drugs or alcohol in the past 3 years? *YesNoEducation High SchoolAddressFromToDid you graduate?YesNoDegree CollegeAddressFromToDid you graduate?YesNoDegree OtherAddressFromToDid you graduate?YesNoDegreePrevious Employment Do you have previous work experience? *YesNoCompany *City, State, Zip *Phone *0 / 14SupervisorJob Title *Starting SalaryUSDEnding SalaryUSDResponsibilitiesFrom *To *Reason for leaving *May we contact this employer for a reference?YesNoAdd another previous employer? *YesNoCompany *City, State, Zip *Phone *0 / 14SupervisorJob Title *Starting SalaryUSDEnding SalaryUSDResponsibilitiesFrom *To *Reason for leaving *May we contact this employer for a reference?YesNoAdd another previous employer? *YesNoCompany *City, State, Zip *Phone *0 / 14SupervisorJob Title *Starting SalaryUSDEnding SalaryUSDResponsibilitiesFrom *To *Reason for leaving *May we contact this employer for a reference?YesNoAdd another previous employer? *YesNoCompany *City, State, Zip *Phone *0 / 14SupervisorJob Title *Starting SalaryUSDEnding SalaryUSDResponsibilitiesFrom *To *Reason for leaving *May we contact this employer for a reference?YesNoAdd another previous employer? *YesNoCompany *City, State, Zip *Phone *0 / 14SupervisorJob Title *Starting SalaryUSDEnding SalaryUSDResponsibilitiesFrom *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? *YesNoBranch *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. LocationDateChargePenaltyLocationDateChargePenaltyLocationDateChargePenaltyLocationDateChargePenaltyLocationDateChargePenaltyExperience and Qualifications LicensesState *SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingLicense Number *Type (A,B,C) *Expiration Date *StateSelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingLicense NumberType (A,B,C)Expiration DateStateSelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingLicense NumberType (A,B,C)Expiration DateClass of EquipmentStraight Truck *YesNoYear Began *Year End *Miles DrivenTractor-Trailer *YesNoYear Began *Year End *Miles DrivenTractor-Double Trailers *YesNoYear Began *Year End *Miles DrivenTractor-Tank Trailer *YesNoYear Began *Year End *Miles DrivenTractor-Flat Trailer *YesNoYear Began *Year End *Miles DrivenDo you have any experience operating a manual transmission? *YesNoPlease give the extent of your experience: Accident record for the past 3 years, minimum. DateNature of Accident (rear-end, roll-over, head-on, etc.)Deaths?YesNoInjuries?YesNoDateNature of Accident (rear-end, roll-over, head-on, etc.)Deaths?YesNoInjuries?YesNoDateNature of Accident (rear-end, roll-over, head-on, etc.)Deaths?YesNoInjuries?YesNoAdditional Information Upload Additional InformationDrag and Drop (or) Choose FilesResume, 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. I have read, understand, and acknowledge the receipt of the disclosure and authorization, and I authorize Company to obtain the consumer report and/or investigative consumer report. I agree that a facsimile ("fax"), electronic, or photographic copy of this Authorization shall be as valid as the original. Disclaimer and Signature I certify that my answers are true and complete to the best of my knowledge.If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.Signature *Date *Submit