Pistoresi Trucking
Pistoresi Drivers Job Application
Applicant: Please read and sign this statement before submitting this application:I understand that the information provided in this application will be used to check my background, motor vehicle record secured by this company, work history, safety performance history, and USDOT drug & alcohol testing information and that previous employers will be contacted for purposes of investigation as required by 391.23 FMCSR.I understand that I have certain due process rights that include the right to have corrected an erroneous Safety Performance History per 391.23(j)(1). If a previous employer refuses to correct the erroneous Safety Performance History, the driver may send a rebuttal per 391.23(j)(3). This rebuttal shall be attached to the previous employer’s files for the driver so that it is included in any further requests for safety performance history information and provide a copy to us.
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Were you subjected to the FMCSR while employed by previous employers? *
Required
Was your job designated as a safety sensitive function in any USDOT regulated industry subject to the drug and alcohol testing requirements of 49 CFR Part 40? *
Required
Signature of Applicant *
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According to FMCSR, the applicant must complete all information requested.If it does not apply to you put in “N/A.” Do not leave any blanks on the application.Please Print ClearlyIn compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.
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Name: First, Middle, Last *
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SS Number *
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Present Address *
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Previous Address *
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Telephone Number *
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Are you over the age of 23 years? *
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Have you worked for NP&S before? *
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DATES: FROM
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Position
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Reason for Leaving
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Are you currently employed? *
Required
If so, how much notice do you have to give? *
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Position Applying For *
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Who referred you?
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Rate of pay excepted
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APPLICANT MUST READ AND SIGN: I certify that I have read and understood this application and all answers are true and accurate. I agree and understand that I am authorizing Nello Pistoresi & Son, Inc to investigate my background in order to check any and all information concerning my employment history, whether included in this application or not. I release Nello Pistoresi & Son, Inc. and all previous employers contacted by Nello Pistoresi & Son, Inc. from all liability for any damages, real or imagined, as a result of providing information as a part of the application process. I understand that as an applicant for a position with Nello Pistoresi & Son, Inc, I will be required to certify that I am capable of performing the tasks required by the job. I understand that a Department of Transportation drug screen urine test must be taken and that no job offer will be made until the results of the drug screen are returned from the screening agency. I understand that if the drug screen is positive no job offer will be made. I also understand that, after a positive drug screen, I will be referred to a Substance Abuse Professional by Nello Pistoresi & Son, Inc.I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment with Nello Pistoresi & Son, Inc. and for no other reason.I agree to furnish all additional information including a copy of a valid CDL, a current Medical Card, a valid Social Security Card, and a work permit if not a citizen or take other additional examinations as may be required to complete my application file.I also understand that misrepresentation or omission of information or pertinent facts may result in the rejection of this application or dismissal.If hired, I agree to abide by all the rules of the FMCSR and the rules and policies of Nello Pistoresi & Son, Inc.My signature below certifies that this application was completed by me, and that all entries on it and information in it are true, complete, and accurate to the best of my knowledge.Applicant Signature *
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List your Dock equipment experience and the number of years of
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Please Check the Dock equipment below you have an operator's card for:
Indicate classes or special training in Dock handling equipment you have taken
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Driver Licenses. State *
License No *
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Type
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Expiration Date *
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Have you ever been denied a license, permit, or privilege to drive? *
Required
If "Yes" please explain
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Has any license, permit, or privilege to drive been suspended or revoked? *
Required
If "Yes" please explain
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Truck Experience *
Required
List States in which you have driven a CMV in last five years: *
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List CMV special classes or training taken that will help you as a driver
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List CMV Safe Driving Awards and from whom
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E M P L O Y M E N T H I S T O R Y List all present and past employment, beginning with the most recent. List all truck driving jobs back ten (10) years. If you have not driven for ten years, list truck driving jobs back to and including the job you had before you began truck driving.1. Company Name *
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Dates From-Date to *
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Position Held *
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Address *
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City *
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State *
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Zip *
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Business Phone No. *
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Fax Phone No.
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Type of Business *
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Applicant's Duties
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Name of Supervisor *
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Reason For Leaving *
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2. Company *
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Date From- Date to *
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Position Held
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Address *
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City *
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State *
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Zip *
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Business Phone No. *
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Fax Phone No.
Type of Business *
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Applicant's duty and Responsibilities
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Name of Supervisor *
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Reason for leaving *
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3. Company Name
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Date from-Date to
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Position Held
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Address
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City
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State
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Zip
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Business Phone No.
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Fax Phone No.
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Type of Business
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Applicant's duty and responsibilities
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Name of Supervisor
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Reason for leaving
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