DRIVER Application Apply Today First *Last Name *Street Address *Apartment, suite, etcCity *State *ZIP *Home Phone *Cell Phone *Please choose which you would prefer us to call:Please choose which you would prefer us to call:Home PhoneCell PhoneEmail *Date Available *Full / Part Time *Full / Part TimeFull TimePart TimeAre you available for: *Are you available for:NoneSomeAll WeekendsHave you ever applied for a position with us? *Have you ever been employed by us? *If you answered yes to either of the previous two questions, when? *Are you currently employed? *Are you currently employed?YesNoEducational Data:Enter the name of your High School and how many years you completed: *Enter the name of your College, Graduate School, or other including the number of years you completed, any degrees you obtained, and your major course of study: *Personal References:Name *Phone *Name *Phone *Name *Phone *FMCSA Regulations:For drivers subject to FMCSA Regulations: The Federal Motor Carrier Safety Administration requires that driver applicants state their date of birth and social security number.Date of Birth *Social Security Number:LicensesDriver's License Number:Driver's License State: *Driver's License Class: *Endorsements: *Driver's License Expiration Date: *Have you ever been denied a license, permit, or privelege to operate a motor vehicle? *Has any license, permit, or privilege ever been suspended or revoked? *Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations? *if yes..Driving ExperienceClass of Equipment: *Class of Equipment:Straight TruckTractor & SemiTwin Trailers - LVC'sOtherIf other, enter hereType of Equipment: *Type of Equipment:VanTankFlatReeferOtherIf other, enter hereEnter the dates from/to and total approzimate miles you drove the equipment: *List the states operating in during the last five years: *List special courses or training that will help you as a driver: *List driving awards held and who awards were presented by: *Driving RecordHave you had an accident in the last 3 years? *Have you had an accident in the last 3 years?YesNoIf yes, please explain:Have you had any traffic convictions and forfeitures in the past 3 years other than parking violations? *If yes, please list location, date, charge, and penalty:Employment HistoryCompanyFromToPosition heldSalaryReason for leavingCityStateZipPhoneSupervisorEmployment History (Continued)CompanyFromToPosition heldSalaryReason for leavingCityStateZipPhoneSupervisorEmployment History (Continued)CompanyFromToPosition heldSalaryReason for leavingCityStateZipPhoneSupervisorList any additional jobs:Please explain any gaps in you employment history:May we contact your present empoyer? *May we contact your present empoyer?YesNoIf "no" please explain:In order to permit a check of your work and education records, have you ever been known by another name? (an affirmative response will not automatically disqualify you from being considered for employment.) *If "yes, identify name(s) and relevant dates:Have you ever been dismissed or forced to resign from any employment? *If "yes, please explain:General Information:Will you abide by the safety rules of this company? *Are you legally qualified to work in the U.S.? (proof of citizenship or immigration status will be required upon employment) *Have you ever been convicted of a felony or pleaded guilty or "no contest" to a felony and received deferred adjudication? (An affirmative response will not automatically disqualify you from being considered for employment). *If "yes, please explain:Describe any other special job-related skills or qualifications (e.g. military experience and training, computers, professional associations, licenses, etc.) that would be valuable to the position for which you are applying: *Please sign here *Please sign hereYour browser does not support e-Signature field.Date *Applicant's StatementRead this agreement1. I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also understand and agree that any falsified information or significant omissions may disqualify me from further consideration for employment, and if discovered after I am hired, may result in dismissal. I also affirm that I am making this application because I am sincerely interested in being hired by Long Island Ice and Fuel Corporation, and not for any other purpose. 2. I also understand that if employment is offered and accepted, such employment is not for any specified term and can be terminated at any time, with or without cause and with or without notice, by either the Employer or me. I further understand that this application is nor nor is it intended to be a contract of continued employment, and that my at-will employment status cannot be changed except by a written document singed by the President of Long Island Ice and Fuel Corporation. I further understand that no supervisor, manager or other employee or representative of Long Island Ice and Fuel Corporation, other than the President, has the authority to change the at-will nature of my employment, and that any oral promises of employment for a defined period or statements that are otherwise contrary to my at-will status are not binding upon Long Island Ice and Fuel Corporation. 3. In Consideration for employment, I authorize a thorough investigation of my past employment and activities, agree to cooperate in such investigation, and release from all liability or responsibility all persons and businesses requesting or supplying such information. 4. I understand that if offered employment, I will be required to submit to a drug screening test as a condition of employment. I further understand that refusing to submit to a test, or test results showing any detectable amount of illegal drugs, will subject me to not being considered for employment. 5. I understand and agree that if I am hired, I am required to read and abide by all rules and regulations of Long Island Ice and Fuel Corporation governing the conduct of its employees, including the rules which prohibit the use or possession of illegal drugs, alcoholic beverages, firearms or weapons of any kind in any office, work location, or facility of the Employer. 6. I understand that during my employment, if Long Island Ice and Fuel Corporation has reasonable suspicion that I am under the influence of alcohol while at work, and if it appears that I am having difficulty performing my job safely or effectively due to the suspected use of alcohol, I may be required to submit to alcohol testing as a condition of continued employment. I also understand that drug screen tests may be performed on a reasonable suspicion, post-accident, or random basis during my employment, and that my refusal to submit to a drug or alcohol test will result in immediate dismissal. 7. I understand that if I am offered employment, I may be required, as a condition of employment, to undergo a physical examination for the purpose of determining whether I am able to perform the essential functions of the job for which I am applying. I hereby authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the essential functions of such job. I understand that refusing to submit to the physical examination may result in my not being considered for employment. 8. I understand that Long Island Ice and Fuel Corporation is a subscriber under applicable State Workers' Compensation Acts. 9. If offered employment in a position which requires driving while on duty, I understand that being insurable by Long Island Ice and Fuel Corporation's automobile liability insurance carrier, or otherwise having a safe driving record (which includes keeping a valid driver's license); immediately reporting any accidents or traffic violations to the Employer; and satisfaction of Department of Transportation and other applicable regulations, are conditions of my employment or continued employment. If hired, I understand that should I fail to satisfy any of the above requirements, I may be subject to immediate discharge. 10. I agree that if I am hired, I will not, during the term of my employment, become associated with or engage in any work or business that is directly or indirectly competitive with Long Island Ice and Fuel Corporation, or that otherwise conflicts with the best interest of Long Island Ice and Fuel Corporation. 11. I Represent and warrant to Long Island Ice and Fuel Corporation, that I am free to become employed by Long Island Ice and Fuel Corporation and that I have no obligations to any former employer or otherwise that would prevent me form being hired by Long Island Ice and Fuel Corporation. I further represent and agree that I have not and will not improperly disclose to Long Island Ice and Fuel Corporation any confidential business information, trade secrets, or proprietary information belonging to any former employer or other party ("Confidential Information"). Moreover, I agree that if I am employed by Long Island Ice and Fuel Corporation, I will not improperly disclose Confidential Information to which I gain access by virtue of my employment. 12. I certify that I am eligible for employment in the United States, and that the documents I furnished, or will furnish, to verify my identity and eligibility are true and correct. I further understand and agree that if offered employment, I will have three days to submit such documents, and that failure to submit such documents within three days will result in withdrawal of the offer of employment, or if employment has begun, termination from employment.If you have read and agree to the terms of the information above: *I agreeNoteNote: this application will be retained for active consideration for employment until the position applied for is filled. After the position applied for is filled, the applicant will need to complete a new application if he/she wishes to be considered for employment in positions that later become open. SUBMITPlease do not fill in this field.