Xtreme Manufacturing LLC.

California Driver

Application for Employment

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.

Application Date:


We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status or any other legally protected status.

Please answer all questions, indicating "None" where applicable. Resumes may be attached but will not be accepted in lieu of any information required on this form. This application must be completed in its entirety before any offer of employment will be considered.

Position Applying For

*

*
*


General Information

*

*
*
*
*
*
*





*

*
*
*
*


If you have not lived at your current address at least 3 years, please complete table below:




















Drivers License Information

*
*
*

*


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

Has any license, permit or privilege been suspended or revoked?


Driving Experience

Straight Truck


Tractor and Semi-Trailer


Tractor and Two-Trailers


Tractor and Three-Trailers


Coach Bus more than 8 passengers


Coach Bus more than 15 passengers



Any Motor Vehicle Accident Record for the Past Three (3) Years ?

Check here if yes

Last Accident

Previous Accident

Previous Accident

Previous Accident

Previous Accident


Any violations of motor vehicle laws or ordinances (other than parking violations) for which you were convicted or forfeited bond or collateral for the last three (3) years ?

Check here if yes

Last Violation

Previous Violation

Previous Violation

Previous Violation


Additional Information

Are you able to perform the essential functions of the job you're applying with or without reasonable accommodation(s)?*

Have you ever filed an application with Xtreme Manufacturing LLC. before?

Do we currently employ a member of your family or household?

Have you ever been employed with Xtreme Manufacturing LLC.?

Are you currently employed?*

May we contact your present employer?*

Are you authorized for employment in the U.S.?*






Education / Training

Have you ever had any job-related training in the military?

Please select which schools you have attended

High School

Years Completed

College/Undergraduate

Years Completed

Graduate/Professional

Years Completed

Other School

Years Completed

Diploma/Degree

Date

Describe Course of Study

Describe any specialized training/skills

State any additional information you feel may be helpful to us in considering your application

List any professional, trade, business, or civic activities and offices held.


References

Give the name, address and telephone number of three persons whom you have known for at least one (1) year. Please do not use relatives or previous employers/supervisors.

*
*
*

*
*


*
*
*

*
*


*
*
*

*
*


Employment

Start with your most recent and list all employment for the last ten (10) years. Explain all gaps in your employment, including periods of unemployment and self-employment. Resumes may not be substituted for requested information.

Check here if you do not have employment history, otherwise check here to continue. Thank you*.


Employer #1

Employer Name*
Employed from*
Employed to*
*
*
*
*
*
*
*

For this employer: Were you subject to the Federal Motor Carrier Safety Regulations?

Were you in a safety sensitive function that subjected you to alcohol & controlled substances testing requirements?






Description of Duties.*

Employer #2

Employer Name*
Employed from*
Employed to*
*
*
*
*
*
*
*

For this employer: Were you subject to the Federal Motor Carrier Safety Regulations?

Were you in a safety sensitive function that subjected you to alcohol & controlled substances testing requirements?






Description of Duties.*

Employer #3

Employer Name*
Employed from*
Employed to*
*
*
*
*
*
*
*

For this employer: Were you subject to the Federal Motor Carrier Safety Regulations?

Were you in a safety sensitive function that subjected you to alcohol & controlled substances testing requirements?






Description of Duties.*

Employer #4

Employer Name*
Employed from*
Employed to*
*
*
*
*
*
*
*

For this employer: Were you subject to the Federal Motor Carrier Safety Regulations?

Were you in a safety sensitive function that subjected you to alcohol & controlled substances testing requirements?






Description of Duties.*

Employer #5

Employer Name*
Employed from*
Employed to*
*
*
*
*
*
*
*

For this employer: Were you subject to the Federal Motor Carrier Safety Regulations?

Were you in a safety sensitive function that subjected you to alcohol & controlled substances testing requirements?






Description of Duties.*


Please list any gaps in unemployment and/or explain if employment listed is less than 10 years.


Click here if you would like to send us a copy of your resume


I, *, warrant the truthfulness on this day *, the information provided in this application.

I understand that selecting this constitutes a legal signature confirming that I acknowledge and agree to the above Certification and Agreement.