Employment Application

In compliance with Federal and State equal employment opportunity laws, qualified applicant are considered for all positions without regards to race, color, religion, sex, national origin or any other protected group status.

Required fields are followed by * meaning you must provide the requested information to continue.

1. GENERAL

First Name:*

Middle Name:

Last Name:*

Primary Phone:*

Secondary Phone:

E-mail:

Current Address:*

City:*

State:*

Zip Code:*

For how long?:*

(If at the above address less than three years, list all addresses for the past three years.)

Click here to add more addresses

Date of Birth:*

Social Security No.:*

Are you currently leased?:*

Yes No

In Case of Emergency Please Notify:

Name:*

Address:*

City:*

State:*

Zip Code:*

Phone:*

Click here to add more emergency contacts

Have you worked for DTI before?:* Yes No

Do you have any friends and/or relatives working for DTI?: Yes No

How did you hear about DTI?:

Referred by DTI Driver:

2. LICENSE

List all commercial drivers licenses/permits held in past (3) three years

State:*

Expires:*

Endorsements:

CDL License Number:*

Click here to add more licenses or permits

3. EMPLOYMENT RECORD FOR PAST 10 YEARS

Begin with your present or most recent job and work backward in order, listing your employers for at least (10) ten years. All time must be accounted for including periods of unemployment. PHONE NUMBERS MUST BE PROVIDED FOR ALL EMPLOYERS.

I am currently unemployed

Current Employer:*

When (From)::*

(To)::*

Address:*

City:*

State:*

Zip Code:*

Phone:*

Fax:

Supervisor Name:

Position:

Equipment:

Click here to add more past employers

4. DRIVING RECORD/QUALIFICATIONS

Traffic Violations

Have you ever been convicted for a traffic violation?:* Yes No

Accident Record:

Have you ever had an accident?:* Yes No

Equipment Experience:*

List all experience in the last ten (10) years.

Tractor with Van:* Yes No

Tractor with Reefer:* Yes No

Tractor with Flatbed:* Yes No

Tractor with Tanker:* Yes No

Tractor with Belly Dump:* Yes No

Trailer with End Dump:* Yes No

Other:* Yes No

Click here to add more equipment experience

If answer to any of the above questions is yes, give the dates and circumstances:*

Please print and fill out the Fair Credit Reporting Act Disclosure Statement and the Request for Information From Previous Employer forms and submit them to our Human Resources department for processing.

All submitted information will be held in the strictest confidence.

Mail the forms to:
Dahl Trucking Inc.
Attn: Human Resources
305 South Highway 169
Elmore MN, 56027

Or fax the forms to:
507-943-3415

TO BE READ AND SIGNED BY THE APPLICANT

I hereby authorize and request any former employer, lessee, treating physician or hospital or any other persons or companies, including any city, county, state or federal agency, department or bureau, to furnish any information in their files under my name. I agree to hold any source of information harmless for any damages on account of furnishing any such information. A photocopy of this authorization may be accepted by anyone as though it were the original. In submitting this driver application, I understand that this investigative report may include personal interviews with third parties, such as past employers, business associates, financial sources, friends or others. This inquiry may include information about my character, general reputation, personal characteristics, and mode of living. I understand that I must successfully complete a D.O.T. physical including a drug test, as required to complete my qualification file. This application does not obligate the company in any way, and that, if qualified, my qualification can be terminated, with or without cause, at any time at the option of either the company or myself. I certify all statements on this form are complete and correct to the best of my knowledge. I also agree that falsified information or significant omissions may result in my disqualification now or at any time.

Copy and paste this:
Here:

There are errors in your form.

1.	Have you ever been denied a license, permit or privilege to operate a motor vehicle?*	Yes No
2.	Have you ever had any license, permit or privilege to drive suspended or revoked?*	Yes No
3.	Have you ever been convicted for driving while under the influence of alcohol or drugs?*	Yes No
4.	Have you ever been on worker's compensation?*	Yes No
5.	Have you ever been disqualified to drive by Federal Regulations?*	Yes No
6.	Have you ever been denied entry into Canada?*	Yes No
7.	Have you ever been convicted of a felony?*	Yes No
8.	Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)?*	Yes No

Employment Application

1. GENERAL

In Case of Emergency Please Notify:

2. LICENSE

3. EMPLOYMENT RECORD FOR PAST 10 YEARS

4. DRIVING RECORD/QUALIFICATIONS

Traffic Violations

Accident Record:

Equipment Experience:*

Final Questions:*

TO BE READ AND SIGNED BY THE APPLICANT