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Non-Driver Application

Non-Driver Application

"*" indicates required fields

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Applicant Information

Full Name*

First Middle Last

Phone*

Email*

Current and Prior Addresses

Provide your addresses for the past 3 years. Upload list of additional addresses if more space is needed.

Current Address*

Street Address Address Line 2 City State ZIP Code

Have you lived at this address for less than 3 years?*

Yes

No

Previous Address*

Street Address Address Line 2 City State ZIP Code

Have you lived at another address within the past 3 years?

Yes

No

Previous Address*

Street Address Address Line 2 City State ZIP Code

Have you lived at another address within the past 3 years?

Yes

No

Previous Address*

Street Address Address Line 2 City State ZIP Code

Is your mailing address different from your current address?

Yes

No

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Employment Desired

Desired Position*

Desired Salary*

Date Available to Start*

Month

Day

Year

Are you employed now?*

Yes

No

Are you legally authorized to work in the United States?*

Yes

No

Education History

List of Education History*

Please enter each school that you attended, including high school, college, and trade schools if applicable. (Click the + button to add a new row)

School Name

Address

Years Attended

Did You Graduate?

Subjects Studies

Other Qualifications*

Please list any other qualifications which you have and which you believe would be important for consideration by the company pertaining to this application.

Employment History

The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you hold a CDL or have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for a total of ten (10) years). Any gaps in employment in excess of one month and/or unemployment must be explained. Upload an additional sheet in the file upload field at the end of this application if more than 2 previous employers must be added.

Current (Most Recent) Employer

Company Name*

Company Phone*

May we contact this employer?*

Yes

No

Position Held*

Salary*

Dates Employed*

From

To

Reason for Leaving?*

Company Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Was this position subject to Federal Motor Carrier Safety Regulations (FMCSR)?*

Yes

No

Was this position subject to alcohol/controlled substances testing requirements under 49 CFR, Part 40?*

Yes

No

Previous Employer 1 (Optional)

Company Name

Company Phone

May we contact this employer?

Yes

No

Position Held

Salary

Dates Employed

From

To

Reason for Leaving?

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Was this position subject to Federal Motor Carrier Safety Regulations (FMCSR)?

Yes

No

Was this position subject to alcohol/controlled substances testing requirements under 49 CFR, Part 40?

Yes

No

Previous Employer 2 (Optional)

Company Name

Company Phone

May we contact this employer?

Yes

No

Position Held

Salary

Dates Employed

From

To

Reason for Leaving?

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Was this position subject to Federal Motor Carrier Safety Regulations (FMCSR)?

Yes

No

Was this position subject to alcohol/controlled substances testing requirements under 49 CFR, Part 40?

Yes

No

If you need to list additional employers, please upload a document with that list at the end of this application using the document upload field.

Previous Employment Drug Testing

Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer that you have applied for, but did not obtain, safety-sensitive work covered under the Department of Transportation’s drug and alcohol testing rules during the past two years?*

Yes

No

If yes, can you prove that you have completed the DOT return to duty process as detailed in 49 CFR Part 40, Subpart O.?*

Yes

No

Military Service

If you have U.S. Military or Naval service, please complete this section.

Dates of Service

Branch & Rank

Present Membership in National Guard or Reserves

References

Please list at least one and not more than three professional references.

Reference 1*

Full Name

Relationship

Company

Address

Phone Number

Reference 2

Full Name

Relationship

Company

Address

Phone Number

Reference 3

Full Name

Relationship

Company

Address

Phone Number

Certifications & Acknowledgements

Please read each statement closely and check next to each, acknowledging your understanding. If clarification is needed, please contact Human Resources.

Equal Employment Opportunity Statement*

This company is committed to the principles of equal employment opportunity and is committed to make employment decisions based on merit. We are committed to complying with all Federal, State and local laws providing for equal employment opportunities, as well as all laws related to terms and conditions of employment. The Company desires to maintain a work environment that is free of sexual harassment and discrimination due to race, religion, color, national origin, physical or mental disability, age or any other status protected by Federal, State or local laws. The Company will make reasonable efforts to accommodate those physical or mental limitations of an otherwise qualified employee unless undue hardship would result for the company.

Discrimination and Sexual Harassment Policy Statement*

This Company will not tolerate any form of unlawful discrimination, including sexual harassment. Any employee who engages in unlawful discrimination or sexual harassment will be subject to appropriate discipline, up to and including termination. Prohibited sexual harassment is defined as follows: Unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature constitutes sexual harassment when (1) submission to such conduct is made whether explicitly or implicitly a term or condition of an individual’s employment; (2) Submission to or action of such conduct by an individual is used as the basis for employment decisions affecting such individuals; or (3) Such conduct has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile or offensive work environment.

Disclosure to Applicants Concerning Drug/Alcohol Testing*

If you are offered a position with the Company, you may be given a drug/alcohol test as a condition of employment. Your refusal to timely submit to a drug/alcohol test or your failure to pass such a test means you will not be employed by this company. Neither the collector of specimens nor the medical professional who reviews the test results will be a company employee. The test results will be kept confidential. The individual undergoing testing will not be directly observed while providing the specimen unless there are reasonable grounds to believe the individual may alter or substitute the specimen. Negative test results are required as a condition of employment.

Complete and Accurate Information*

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission or misstatement of material fact on this application, or any other document used to secure employment, shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

At-Will Employment*

I understand and agree that if I am employed, my employment will be “at-will”, which means that the Company may terminate the employment relationship at any time, with or without cause and with or without notice. Likewise, the Company will respect my right to terminate my employment at any time, with or without cause and with or without notice. I further understand that any prior representation, whether expressed or implied to the contrary is hereby superseded and that no promise or representation contrary to the foregoing is binding on the Company unless made in writing and signed by the Company’s president.

Testing Authorization*

If offered a position with the Company, I hereby agree to any legally permitted physical, psychological, skill, drug or medical test required by the Company as a condition of employment.

Background Investigation Authorization*

I authorize investigation into all statements and references contained in this application. Said investigation may include interviews with past employers, workers and friends. Said investigation may include credit, driving, criminal background, references and other background checks. As a condition of applying for this job, I authorize reasonable post-hire investigations into my credit, driving and criminal background.

Company Obligation*

I understand and agree that the Company’s acceptance of this job application does not mean that a position for which I am qualified is open (unless specifically posted) or that the company has agreed to hire me. I understand that the Company is under no obligation to hire me as the result of accepting this completed application.

TO BE READ AND SIGNED BY APPLICANT

This also certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

Signature*

Full Name*

Today's Date*

MM slash DD slash YYYY

Resume/File Upload (optional)

If you have a resume or additional documents you would like to attach, please do so here. This is not required.

Drop files here or

Accepted file types: doc, docx, pages, odt, rtf, tex, txt, wpd, wps, pdf, Max. file size: 5 MB, Max. files: 5.

Your information is processed securely, and is never shared, distributed, or sold to any third parties. By providing a telephone number and submitting the form you are consenting to be contacted by voice or SMS text message. Message frequency may vary. Message & data rates may apply. Reply STOP to opt-out, Reply HELP for more information.

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2075 S Wesleyan Blvd
Rocky Mount, NC 27803

1621 Navaho Dr
Raleigh, NC 27609

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