Careers

Application for Employment

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Alpha Logistics LLC

3416 Corwin RD Ste-A

Williamston, MI 48895

In 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.

Date Of Application: Position Applied for:

Name: Social Security No: - -

(List your addresses of residency for the past three years)

Current Address:

State: Zip Code: Phone #: Cell Pager

Previous Address: How Long?

Do you have the legal right to work in the United States?

Date Of Birth: / / Can you provide proof of age?

(Required For Commercial Drivers)

Have you worked for this company before? From: / / To: / /

Reason For Leaving?

Are you now employed? If not, how long since leaving last employment?

Who referred you? Rate of pay expected:

Is there any reason you might be unable to perform the functions of the job?

If yes, would you like to explain?

EMPLOYMENT HISTORY (10 Years - List employers in reverse order, NO GAP per D.O.T. GUIDELINES)

According to ATR Policy & DOT Guidelines. List employers in reverse order starting with the most recent. List COMPLETE address. NO GAP IN EMPLOYMENT HISTORY PER D.O.T. GUIDELINES.

Employer #1

EMPLOYER NAME:

FROM: / TO: /

ADDRESS:

POSITION HELD:

CITY: STATE: ZIP:

SALARY/WAGE: CONTACT PERSON: PHONE NO.:

REASON FOR LEAVING:

WERE YOU SUBJECT TO THE FMCSRS WHILE EMPLOYED? YES NO

WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION (49 CFR PART 40)? YES NO

ACCIDENT RECORD FOR PAST 3 YEARS (If None, Write NONE)

List most recent accident first.

Accident #1

DATE:

NATURE (HEAD ON, REAR-END, UPSET):

FATALITIES:

INJURIES:

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)

If None, Write NONE.

Conviction #1

LOCATION:

DATE:

CHARGE:

PENALTY:

EDUCATION

Circle highest grade: 1 2 3 4 5 6 7 8 High School: 1 2 3 4 College: 1 2 3 4

Last School Attended:

DRIVER LICENSES

STATE	LICENSE NO.	TYPE	EXPIRATION

A. Denied a license? YES NO

B. Suspended or revoked? YES NO

DRIVING EXPERIENCE (IF NONE, WRITE NONE)

CLASS OF EQUIPMENT / TYPE (VAN, TANK, FLAT, ETC.) / DATES / MILES

Experience #1

CLASS:

TYPE:

DATES FROM:TO:

APPROX. MILES:

States operated (last 5 years):

Special courses:

Safe driving awards:

OTHER EXPERIENCE

Courses/training:

Special equipment:

TO BE READ AND SIGNED BY APPLICANT

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize Alpha Logistics LLC to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. I hereby release employer, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

Date: Applicant's Signature:

Interviewed By: Date: