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APPLICATION FOR EMPLOYMENT

The individual requesting qualification with Atlanta Peach Movers (APM) must complete the rest of this Request for Qualification. Any falsification or incomplete information may result in the Request being rejected and/or shall be grounds for terminating the relationship. In order that your Request may be properly evaluated, it is essential that all of the following information be answered carefully and completely. Applicants will be considered regardless of race, sex, age, religion, national origin, marital status, disability or veteran’s status, or any other basis prohibited by federal, state, or local law. We do not tolerate discrimination
Max. file size: 256 MB.

EDUCATION

MM slash DD slash YYYY
Position(s) applying for:(Required)
Name
Address
MM slash DD slash YYYY

FORMER RESIDENCE: List last two (2) years of former residence. (Use back of sheet if necessary)

Address
Address

PERSONAL WORK REFERENCES:P List two (2) additional references that can also be used to verify unemployment, self-employment, or previous employers that are no longer in business.

Name
Name
Have you ever applied for a position with Atlanta Peach Movers?
Are you a United States Citizen?
Are you legally entitled to work in the Untied States?
Max. file size: 256 MB.
(The Immigration Reform and Control Act of 1986 Requires That You Respond To The Above Inquiries)

PERSONAL INFORMATION

Have you ever taken any truck driver programs

If yes, List any truck driver-programs completed:

MILITARY SERVICE

Have you served in the U.S. Armed Forces:

EMPLOYMENT HISTORY

Starting with your current employer, list in chronological order all employers, self-employment and unemployment of the past five (10) years.

Address
May we contact this employer?

USE THIS SHEET FOR ADDITIONAL EMPLOYMENT HISTORY INFORMATION

Address
May we contact this employer?

Address
May we contact this employer?

Address
May we contact this employer?

Address
May we contact this employer?

1. Have you EVER been convicted for the use of alcohol?
MM slash DD slash YYYY

2. Have you EVER been convicted for the possession, use, sale, manufacture, dispensation, or distribution of any controlled substances?
MM slash DD slash YYYY

3. Have you EVER been convicted of any misdemeanor offenses?
MM slash DD slash YYYY
MM slash DD slash YYYY

4. Have you EVER been convicted of any misdemeanor offenses?
MM slash DD slash YYYY
MM slash DD slash YYYY

5. Have you EVER been incarcerated or served a prison term?

6. Have you EVER been on or are you currently on court-assigned probation, parole, supervision?

7. Are you currently involved in a pending court action? If yes, indicate the nature of the action and the location of the court.

8. Have you ever tested positive or voluntarily refused to be tested for any D.O.T. mandated drug or alcohol test, inc. pre-employment tests administered by an employer to which you applied, but could not perform safety-sensitive transportation functions.(49 CFR 40.25 (J) )
MM slash DD slash YYYY

Agreement and Authorization To Release Information And Records (To be read and signed by the prospective candidate)

I hereby release all parties, including but not limited to APM, its parent company and their related entities, employees, officers, directors, agents, my personal referenced and previous employers (collectively referred to as Releasees) from any and all liability including, but not limited to, attorney’s fees and costs, any injury or damage that may result from Releasees furnishing information concerning me or any action by releasees taken on the basis of such information.

I agree to submit to a medical examination including a controlled substance test. I understand that if I fail to satisfactorily pass any part of the medical examination I will be rejected. Any positive results obtained from my controlled substance test shall result in the rejection of my request. My signature on this request indicates that I fully understand my responsibility concerning APM’s drug policy and APM’s commitment to a drug-free workplace and that I agree to abide by these policies.

I agree to familiarize myself with and to abide by all present and subsequently revised rules, policies, and/or procedures of APM, its agents, and all regulations of the United States.

I understand that this Request is not intended to be a contract. I further understand that statements that may be contained in policies, practices, or other APM material do not create any contractual guarantee and that APM has the right to modify, amend or terminate policies, practices, benefit plans, or other APM programs within the limits and requirement imposed by law. This certifies that this Request was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge. In the event my request is accepted, I understand that false, misleading, or omitted information may result in rejection of my Request and/or termination.


I hereby authorize Atlanta Peach Movers or its designated agents, to conduct a thorough investigation of my past employment, education, criminal history, credit history, workers compensation history, motor vehicle records, references and activities as needed to determine my qualification with APM. I authorize all persons who may have information relevant to this investigation to disclose such information to APM or its agents. This specifically includes the release of information by my present and former employers (listed on pages 3 & 4 of this request), law enforcement agencies, courts, criminal justice agencies, educational institutions, financial institutions, military records, landlords, creditors, and others, whether or not specifically mentioned herein. I hereby release any individual, including record custodians, from any and all liability for damages of whatever kind or nature which may at any time result to me on account of compliance, or any attempts to comply with this authorization. I also understand and agree that APM may share personal information with other organizations as required or permitted by law.

I understandthe information I provide regarding current and/or previous employers may be used, and those employers will be contacted for the purpose of investigating my performance history. I understand that I have the right to review the information provided by previous employers; To have errors in the information corrected by the previous employers and for that previous employer to re-send the corrected information to the prospective employer; Have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the applicant cannot agree on the accuracy of the information.

I understandthat as a condition of being certified to drive interstate under the operating authority for APM, I must give APM written authorization to obtain the results of any and all drug and/or alcohol tests during the past three (3) years as required by 49 CFR 382.413 & 40.25. This authorization applies to all employers (listed on pages 3 & 4 of this request). And applies to: Verified positive drug tests; Alcohol tests with a confirmed breath alcohol concentration of 0.04 or greater; Refusals to be testing regulations.

I understand that my signing of this authorization signifies I have read and fully understand this authorization and give my voluntary approval to release my information as needed for employment with APM. In signing below, I certify that all of the information which I have furnished on this form is true and complete to my knowledge. Reproduction of this authorization shall be valid as the signed original and it does not carry an expiration date.

Address

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