RAVEN TRANSPORT HOLDING
6800 Broadway Avenue
Jacksonville, FL 32254
(877) 877-5058 (Toll-Free)
APPLICATION FOR EMPLOYMENT (Company Driver)
Required fields are indicated by an asterisk *

NOTICE: BY SUBMITTING THIS FORM, YOU ARE AGREEING THAT YOU HAVE READ ALL DOCUMENTATION STATED HEREIN AND AGREE TO ALL POLICIES PROVIDED BY RAVEN TRANSPORT.  SUBMISSION OF THIS FORM WILL ACT AS YOUR SIGNATURE THAT ALL YOUR INFORMATION IS CORRECT AND COMPLETE.

Referred Driver: Truck No:

* Date:

WE ARE AN EQUAL OPPORTUNITY EMPLOYER
APPLICANT'S STATEMENT

I understand that if I am hired, my employment will be for no definite period, regardless of the period of payment of my wages. I further understand that I have the right to terminate my employment at any time with or without notice, and the company has the same right. No one other than the Officers of this Company has authority to modify this relationship or make any agreement to the contrary. Any such modification or agreement must be in writing.

I understand that the Company reserves the right to require me to submit to a drug test at any time and also reserves the right to require me to submit to an alcohol test and/or medical examination to the extent permitted by law.

I authorize the company to investigate my driving record, my criminal record and my credit history, and I understand that an investigative consumer report may be prepared whereby information is obtained through personal interviews with neighbors, friends and others with whom I am acquainted. This inquiry would include information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation.

I further understand that the Company may contact my previous employers and I authorize those employers to disclose to the Company all records and other information pertinent to my employment with them. I also authorize the Company to provide truthful information concerning my employment with it to my prospective employers and I agree to hold it harmless for providing such information.

I certify that all of the information that I provide on this application and in any interviews will be true and accurate. I
understand that if I am employed and any such information is later found to be false or misleading in any respect, I may be dismissed.

DO NOT CONTINUE UNTIL YOU HAVE READ AND UNDERSTAND THE STATEMENT ABOVE

PERSONAL DATA

*E-Mail Address

*First Name *Middle

*Last Name

*Social Security No.

List your addresses of residency for the past 3 years.
*Current Address
*Street   
*City          *State    *Zip Code
*Phone Cell Phone
How long?

Previous  Addresses
Street   
City          State    Zip Code
How long?

Street   
City          State    Zip Code
How long?

PRESENT EMPLOYER	DATE
*Name      *Address   *City             *State    *Zip  *Phone          Fax   Reason for Leaving	*from     *to         salary   position
PAST EMPLOYER	DATE
Name      Address   City             State    Zip Phone          Fax   Reason for Leaving	from     to         salary   position
PAST EMPLOYER	DATE
Name      Address   City             State    Zip Phone          Fax   Reason for Leaving	from     to         salary   position
PAST EMPLOYER	DATE
Name      Address   City             State    Zip Phone          Fax   Reason for Leaving	from     to         salary   position

 
*Date of Birth:
Can you provide proof of age?
Yes   No

Have you ever worked for this company before?
Yes   No

If Yes, Where and When?


Were you referred to us by a Raven Driver?
Yes   No

If Yes, who?

If employed, how would you get to and from work?

*Have you ever pled guilty or ''no contest'' to a crime or been convicted of a crime?
Yes   No

*Do you have any criminal charges pending?
Yes   No

If you answered ''Yes'' to either question, Please give date(s) and details of each:
NOTE: Answering ''Yes'' to these questions does not constitute an automatic bar to employment. Only those crimes, which are substantially related to the position you are seeking, will be considered.

Have you ever been terminated or asked to resign from any job?
Yes   No

If ''Yes'', please explain circumstances:

 

DRIVING INFORMATION
Drivers license information:
*State
*License No.
Type
*Expiration Date
Endorsements/Restrictions
Have you ever been licensed in another State?
If YES, What State and License Number?

Most recent traffic conviction or forfeiture of license (other than parking violations):
Location
Date
Charge
Penalty

(Enter traffic violation information here if more space is needed)


Please list your most recent accident
Date
Nature of Accident
Fatalities?
Injuries?
 
*Has any license, permit or privilege ever been suspended or revoked?
Yes   No

Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Yes   No

*Have you ever been cited for DUI or DWI?
Yes   No

If ''Yes'' to any of these questions, Please explain the circumstances:

DRIVING EXPERIENCE

List States operated in for the last five years


Have you attended accredited Driver Training Schools?
Yes   No

If ''Yes'', what is the name of the school and length of time attended:


EDUCATION
Select Highest Grade Completed (Junior Level): 1 2 3 4 5 6 7 8
Select Highest Grade Completed (High School): 1 2 3 4 None
Select Number of College Years Attended: 1 2 3 4 None
 

Last School Attended
Name of School
City & State
 

NOTE: (Please read) I certify by my signature at the end of this application, that I have read and
understand that under Maryland law, an employer may not require or demand any applicant for
employment or prospective employment or any employee to submit to or take a polygraph, lie
detector or similar test or examination as a condition of employment or continued employment.
Any employer who violates this provision is guilty of a misdemeanor and subject to a fine not to exceed $100.00.

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 knowledge.

*(Applicant's Signature, type your name in the box)

 

RELEASE OF INFORMATION
I authorize the Company to investigate, and parties contacted to release information on my personal,
employment, financial, and/or medical history, including workers' compensation claims and other
matters as may be necessary in relation to my employment, during the course of my employment.
I hereby release employers, schools, health care providers and other persons from all liability in
responding to inquiries and releasing information in connection with this investigation.
*(Signature, type your name in the box)

DISCLOSURE AND RELEASE

In connection with my application for employment (including contract for services) with you, I understand that consumer reports which may contain public record information may be requested from DAC Services, Tulsa, Oklahoma. These reports may include the following types of information: Names and dates of previous employers, reasons for termination of employment, work experience, accidents, etc.. I further understand that such reports may contain public record information concerning my driving record, workers' compensation claims, credit, bankruptcy proceedings, criminal records, etc., from Federal, State and other agencies which maintain such records; as well as information from DAC concerning previous driving record requests made by others from such State agencies, and State provided driving records.

I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY DAC TO FURNISH THE ABOVE-MENTIONED INFORMATION.

I have the right to make a request to DAC, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me which DAC has previously furnished within the two year period preceding my request. I hereby consent to your obtaining the above information from DAC, and I agree that such information which DAC has or obtains, and my employment history with you if I am hired, will be supplied by DAC to other companies, which subscribe to DAC Services.

I hereby authorize procurement of consumer report(s). If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment (or contract) period.
 

*Applicant's Signature (type your name in the box)

       Required fields are indicated by an asterisk *