Pro-Fleet

TRANSPORTATION & LOGISTICS GROUP

Application for Employment

Conditions of employment are stated at the end of this form. Please read carefully before you sign this application.

POSITION APPLIED FOR ________________________________________________________

DATE OF APPLICATION _________________________________________________________

PERSONAL INFORMATION

PLEASE PRINT

FULL NAME SOCIAL SECURITY NUMBER

________________________________________________________________________

PRESENT ADDRESS

________________________________________________________________________

HOW LONG HOME TELEPHONE #

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PREVIOUS ADDRESS

________________________________________________________________________

HOW LONG MESSAGE TELEPHONE #

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IF NO PHONE, HOW MAY WE CONTACT YOU?

________________________________________________________________________

ARE ANY OF YOUR RELATIVES PRESENTLY EMPLOYED WITH THE PRO-FLEET OR ITS DIVISIONS? [ ] YES [ ] NO

IF YES, NAME OF RELATIVE:

________________________________________________________________________

HAVE YOU EVER WORKED FOR PRO-FLEET OR ITS DIVISIONS BEFORE?

[ ] YES [ ] NO

IF YES, WHERE? APPROXIMATE DATE: MO/YR.

________________________________________________________________________

HAVE YOU EVER APPLIED FOR THE COMPANY OR ITS DIVISIONS BEFORE?

[ ] YES [ ] NO

IF YES, WHERE? APPROXIMATE DATE: MO/YR.

________________________________________________________________________

HOW WERE YOU REFERRED:

GENERAL INFORMATION

IF YOU ARE UNDER AGE 18, PLEASE STATE YOUR AGE:

________________________________________________________________________

ONLY U.S. CITIZENS OR ALIENS WHO HAVE A LEGAL RIGHT TO WORK IN THE U.S. ARE ELIGIBLE FOR EMPLOYMENT. CAN YOU, UPON EMPLOYMENT PROVIDE GENUINE DOCUMENTATION ESTABLISHING YOUR IDENTITY AND ELIGIBILITY TO BE LEGALLY EMPLOYED IN THE UNITED STATES?

[ ] YES [ ] NO

HAVE YOU EVER BEEN CONVICTED OF A CRIME OR VIOLATION OTHER THAN A MINOR TRAFFIC INFRACTION?

[ ] YES [ ] NO

(A CONVICTION RECORD WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. FACTORS SUCH AS JOB RELATIONS, AGE AND TIME OF THE OFFENSE, SERIOUSNESS AND NATURE OF VIOLATION AND REHABILITATION WILL BE TAKEN INTO ACCOUNT)

IF YES, PLEASE EXPLAIN:

________________________________________________________________________

HAVE YOU EVER BEEN DISCHARGED FROM ANY EMPLOYMENT OR ASKED TO RESIGN?

[ ] YES [ ] NO

IF YES, PLEASE EXPLAIN:

________________________________________________________________________

REQUIRED FOR TRUCK DRIVERS:

DATE OF BIRTH ____/____/____

DRIVERS LICENSE NUMBER ________________________________________

STATE ISSUED ________

DO YOU CURRENTLY HAVE A VALID LONG FORM CERTIFICATION OF MEDICAL EXAMINATION?

[ ] YES [ ] NO

ARE YOU CURRENTLY OPERATING A CMV UNDER A MEDICAL WAIVER FROM THE FEDERAL MOTOR SAFETY ADMINISTRATION?

[ ] YES [ ] NO

IS THERE ANY REASON YOU MIGHT BE UNABLE TO PERFORM THE FUNCTIONS OF THE JOB FOR WHICH YOU HAVE APPLIED?

[ ] YES [ ] NO

WAGE EXPECTED

________________________________________________________________________

DATE AVAILABLE FOR WORK?

EMPLOYMENT HISTORY

BEGIN WITH YOUR MOST RECENT EMPLOYMENT AND CONTINUE WITH ALL PAST EMPLOYMENT (ATTACH ADDITIONAL SHEET IF NECESSARY)

MOST RECENT / CURRENT EMPLOYER

________________________________________________________________________

FROM TO

________________________________________________________________________

NAME & TITLE OF IMMEDIATE SUPERVISOR

________________________________________________________________________

PHONE NO.

________________________________________________________________________

TYPE OF BUSINESS

________________________________________________________________________STARTING SALARY/ ENDING SALARY JOB TITLE

_______________________________________________________________________

REASON FOR LEAVING (Please Explain)

_______________________________________________________________________

MAY WE CONTACT EMPLOYER?

[ ] YES [ ] NO

NEXT PREVIOUS EMPLOYER

FROM TO

________________________________________________________________________

NAME & TITLE OF IMMEDIATE SUPERVISOR

________________________________________________________________________

PHONE NO.

________________________________________________________________________

TYPE OF BUSINESS

________________________________________________________________________STARTING SALARY/ ENDING SALARY JOB TITLE

_______________________________________________________________________

REASON FOR LEAVING (Please Explain)

_______________________________________________________________________

MAY WE CONTACT EMPLOYER?

[ ] YES [ ] NO

NEXT PREVIOUS EMPLOYER

FROM TO

________________________________________________________________________

NAME & TITLE OF IMMEDIATE SUPERVISOR

________________________________________________________________________

PHONE NO.

________________________________________________________________________

TYPE OF BUSINESS

________________________________________________________________________STARTING SALARY/ ENDING SALARY JOB TITLE

_______________________________________________________________________

REASON FOR LEAVING (Please Explain)

_______________________________________________________________________

MAY WE CONTACT EMPLOYER?

[ ] YES [ ] NO

EDUCATION

HIGH SCHOOL (name and address) YEAR GRADUATED OR GED

________________________________________________________________________

COLLEGE(name and address) YEAR GRADUATED

________________________________________________________________________

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GRADUATE SCHOOL(name and address) YEAR GRADUATED

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BUSINESS, TRADE, OTHER(name and address) YEAR GRADUATED

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ADDITIONAL EXPERIENCE AND QUALIFICATIONS

List any other experience, skills or other qualifications including hobbies, which you believe should be considered in evaluating your qualifications for employment.

Please indicate any prior military service which you would like considered in connection with your application for employment.

________________________________________________________________________

ATTENDANCE AND PUNCTUALITY INFORMATION

Consistent attendance and punctuality are essential requirements of every job with this company. Is there anything which would interfere with your regular attendance and punctuality if you are offered a job with the company?

[ ] YES [ ] NO

If Yes, please explain

_______________________________________________________________________

PERSONAL OR BUSINESS REFERENCES

NAME OCCUPATION:

________________________________________________________________________

PHONE ( ) TITLE:

________________________________________________________________________

RELATIONSHIP HOW LONG KNOWN

________________________________________________________________________

NAME OCCUPATION:

________________________________________________________________________

PHONE ( ) TITLE:

________________________________________________________________________

RELATIONSHIP HOW LONG KNOWN

________________________________________________________________________

NAME OCCUPATION:

________________________________________________________________________

PHONE ( ) TITLE:

________________________________________________________________________

RELATIONSHIP HOW LONG KNOWN

________________________________________________________________________

EXPERIENCE AND QUALIFICATIONS - DRIVER

LIST DRIVERS LICENSES HELD

STATE TYPE EXPIRATION DATE

________________________________________________________________________

LIST ENDORCEMENTS CURRENTLY HELD ON YOUR CDL

________________________________________________________________________

HAVE YOU EVER BEEN DENIED A LICENSE, PERMIT, OR PRIVILEDGE TO OPERATE A MOTOR VEHICLE?

[ ] YES [ ] NO

HAS ANY LICENSE, PERMIT, OR PRIVELEGE EVER BEEN SUSENDED OR REVOKED?

[ ] YES [ ] NO

HAVE YOU EVER BEEN DISCUALIFIED UNDER THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS FOR THE FOLLOWING:

SERIOUS VIOLATIONS

[ ] YES [ ] NO

OPERATING UNDER THE INFLUENCE OF ALCOHOL OR DRUGS

[ ] YES [ ] NO

HAVE YOU EVERBEEN CONVICTED OF A FELONY OR DRIVING UNDER THE INFLUENCE, OR ARE YOU CURRENTLY IN NON-COMPLIANCE WITH A SUPPORT ORDER THAT WOULD PRECLUDE YOUR ENTERING ANY CANADAIAN PROVINCE?

[ ] YES [ ] NO

DO YOU HAVE MOUNTAIN DRIVING EXPERINECE?

[ ] YES [ ] NO

IF YES, WHAT CLASSIFICATIONS OF MATERIALS HAVE YOU HAULED?

________________________________________________________________________

HAVE YOU FAILED, OR REFUSED ANY DOT-MANDATED PRE-EMPLOYMENT SUSTANCE ABUSE SCREENS IN THE PREVIOUS 24 MONTHS?

[ ] YES [ ] NO

DRIVING EXPERIENCE

LIST DRIVING EXPERIENCE/HISTORY

CLASS OF EQUIPMENT – TYPE – DATES - APPROXIMATE TOTAL MILES

________________________________________________________________________

WHAT SAFE DRIVING AWARDS DO YOU HOLD AND FROM WHOM:

_______________________________________________________________________

LIST SPECIAL EQUIPMENT OR TECHNICAL MATERIAL YOU CAN WORK WITH (OTHER THAN THOSE ALREADY SHOWN.)

_______________________________________________________________________

NOTIFICATION AND AGREEMENT

PLEASE READ BEFORE SIGNING

I CERTIFY THAT ALL ANSWERS GIVEN BY ME ARE TRUE, ACCURATE AND COMPLETE, I UNDERSTAND THAT THE FALSIFICATION, MISREPRESENTATION OR OMISSION OF FACT ON THIS APPLICATION (OR ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTS) WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF EMPLOYMENT, REGARDLESS OF WHEN OR H0W DISCOVERED.

Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

It is the policy of the company to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, any and other characteristic protected by Federal, State or Local law.

I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation.

If hired, I agree to abide by all of the company rules and regulation, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the company or me, I further understand that no representation, whether oral or written by any representative or agent of the Company, at any time, can constitute a contract of employment. I understand that the Company and all Plan Administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms or conditions of employment. No representative or agent of the company, has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by the President, or to make any agreement contrary to the foregoing.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me by any means Pro-Fleet deems necessary. I understand and give permission to Pro-Fleet to run a full DAC report, background check, criminal history, substance abuse verification and employment history on me.

APPLICANT SIGNATURE _____________________________ DATE _____________

Please fax completed application to:

HR Department

816-241-1460