New Driver Form|Dynamic Supply Chain Solutions LLC

Date of Application:*

DOB:*

Name*

First Last

SSN:*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone:*

Email:*

Referral Source (How did you hear about us?)*

Are you legally eligible for employement in the country?*

Yes
No

Type of employment desired?*

Full-Time
Part-Time
Seasonal

Answering "yes" to the following question does not constitute an automatic bar to employement. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account

Have you ever pleased "guilty" or "no contest" to, or been convicted of a crime?*

Yes
No

If yes, please proved date(s) and details.*

EMPLOYMENT HISTORY

Are you currently employed?*

Yes
No

If so, may we contact your present employer?*

Yes
No

If you are accepted for employment when would you be available?*

List below present and past employment, BEGINNING WITH THE MOST RECENT

Employer*

Dates Employes*

Position Held*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Contact*

Phone*

Additional Fields

Select All
Add another employer

Employer 2*

Dates Employes 2*

Position Held 2*

Address 2*

Street Address City State / Province / Region ZIP / Postal Code

Contact 2*

Phone 2*

Additional Fields 2*

Add another employer

Employer 3*

Dates Employes 3*

Position Held 3*

Address 3*

Street Address City State / Province / Region ZIP / Postal Code

Contact 3*

Phone 3*

COMMERCIAL MOTOR VEHICLE OPERATORS LICENSE

State*

Number*

Expiration*

State*

Number*

Expiration*

State*

Number*

Expiration*

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

Yes
No

If yes, please explain*

Has one ever been suspended?*

Yes
No

If yes, please explain*

Have you ever been disqualified for violation of Safety Regulations?*

Yes
No

If yes, please explain*

REFERENCES

List three business/work references that are not related to you. If not applicable, list three school or personal references that are not related to you.

Name*

Title*

Phone*

Name*

Title*

Phone*

Name*

Title*

Phone*

QUESTIONAIRE STATEMENT

I certify that all information I have provided in order to apply for and secure employment with this employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents, to contact and obtain informationfrom all references, employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this questionaire, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no questions on this questionaire is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis is prohibited by applicable local, state or federal law.

I understand that this questionaire remains current for only 90 days. At the conclusion of that time, if I have not been notified and still wish to be considered for employment, it ill be necessary for me to reapply and fill out a new questionaire.

I understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect will be sufficient cause to (1) eliminate me from further consideration for employment or (2) may result in my immediate dischsrge from the employer's service, whenever it is discovered. I also understand that this application is for staus as an INDEPENDENT CONTRACTOR and I am responsible for my own WORKERS COMPENSATION INSURANCE.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT

I certify that I have read, fully understand and accept all terms of this Application Statement.

Signature of Applicant*

Date*

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Phone

This field is for validation purposes and should be left unchanged.

New Driver Form

Independent Contractor Driver Questionaire

EMPLOYMENT HISTORY

COMMERCIAL MOTOR VEHICLE OPERATORS LICENSE

REFERENCES

QUESTIONAIRE STATEMENT

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT