Professional Driver

Name

Position you are applying for

Do you have any injuries or chronic physical issues?

Yes No

You may upload your resume, cover letter, or other relevant documents

Phone

Address

City / Code

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Yes No

Have you ever filed an application with us before?

Yes No

Have you ever been employed with us before?

Yes No

Are you currently employed?

Yes No

Are you currently on "lay-off' status and subject to recall?

Yes No

Are you available to work

Full time Part time Shift work Temporary

On what date would you be available for work?

Can you travel if a job requires it?

Yes No

Do you have the ability to perform the ESSENTIAL FUNCTIONS of the job you seek with or without accommodation?

Yes No

If you need an accommodation in order to perform the position of the job you seek please provide the accommodations:

Do you speak any other language(s) besides English?

Yes No

Driving Experience

Yes No

Accident Record (last 5 years)

Yes No

Traffic Convictions and Forfeitures for past 3 years (other than parking violations)

Yes No

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

Yes No

Has any license, permit, or privlege ever been suspended or revoked?

Yes No

Are you a member of the Armed Forces?

Yes No

Are you a member of the National Guard?

Yes No

Have you been convicted of a crime?

Yes No

Are you currently on probation?

Yes No

Applicant's Statement
I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision

I have read, understand, and acknowledge the above statements

Certification of Information
I understand that I am applying for employment with Adler Industrial / Solid Oak Management. By signing below, I declare that the information I have provides in the application process is complete and true to the best of my knowledge. l understand and agree that any false information will result in dismissal at any time during my employment.

I have read, understand, and acknowledge the above statements

Application and Equal Opportunity
Adler Industrial / Solid Oak Management is an Equal Employment Opportunity company. All qualified applicants will receive consideration without regard to gender, marital status, race, color, age, creed, religion, national origin, veteran status or disability. I understand that this form is for use in evaluating my qualifications for employment; it is not an offer or a promise of employment. A background investigation, interview, reference check, various tests and a policy review may be required before any final determination of my suitability for employment is made.

I have read, understand, and acknowledge the above statements

Drug Use and Test
I understand thal Adler Industrial / Solid Oak Management prohibits the use of illegal drugs. l am willing to provide a urine, blood, hair or saliva specimen for drug and/or alcohol testing prior to and/or during my employment as a condition of assignment to certain job positions, or if there is any reason whatsoever to suspect drug or alcohol use. l understand that company policy requires a drug test and alcohol test whenever there is an on-job accident or injury. The drugs that will be tested for are Amphetamines, Batbituates, Benzodiazepines, Cocaine, Methadone, Methaqualone, Propoxphene, Phencyclidine, Opiates including morphine and codeine, and Cannabinoids and any hemp product. We may also perform tests to detect adulterants or substances to mask the detection of drugs. To be qualified for employment with Adler Industrial / Solid Oak Management we must receive a "negative" report on the drug screen. If that qualification is not met, the prospective employee that has been extended and offer will be withdrawn. I hereby release Adler Industrial / Solid Oak Management, its clients and any clinic, individual or test product manufacturer that may administer or provide a drug or alcohol test from any and all claims arising out of the results of such a test, and from any action taken on the basis of those results. I am voluntarily signing below to acknowledge that I have read and fully understand the certification and acknowledgements above. I have the opportunity to ask questions before signing, and all explanation has been in a language I understand.

I have read, understand, and acknowledge the above statements

Release of Information
I further authorize-any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me to Adler Industrial / Solid Oak Management or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or pubic agency may have, to include information or data received from other sources. I hereby release Adler Industrial / Solid Oak Management, the Social Security administration, and its agents, officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may at any time, result to me, my heirs, family, or associates because of the compliance with this authorization and request to release. You may contact me as indicated below. I understand this authorization automatically expires 90 days from the date executed below and that I have the right to revoke the authorization at any time provided I do so in writing. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by the rules and regulations of the employer.

I have read, understand, and acknowledge the above statements

Name

Date

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Qualifications:

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