Connect Logistics Application

Please complete this form and upload your resume.

Applicant Name*

Current Address*

Email*

Position Applying for*

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Start Date

If hired, what is your available start date?

Employment Referral

Who referred you to apply at Connect Logistics?

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Referral Name

Have you worked for Amazon previously?*

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Where?

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Rate of pay:

Are you Currently employed?*

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If yes, where?

Reason for leaving:

Have you ever served in US Armed Forces?

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If yes, which branch

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Are you currently serving in Military Reserves?

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Are you currently serving in the National Guard?

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Have you ever been convicted of a felony?*

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If yes, please explain:

Driver Experience and Qualification*

The Federal Motor Carrier Safety Regulations (49CFR391.21 (B) (2) requires that driver applicants state their date of birth and social security number. Will you provide this information?

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Date of Birth

Social Security Number

Alcohol and Controlled Substance Statement*

The Federal Motor Carrier Safety Regulations 49CFR.25(j) requires all persons applying for a driving position requiring a drivers license to answer the following questions. Within the last two years, have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work?

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Driver's License Information*

Please provide Drivers License number, State issued from, License Class, and Expiration Date:

Licence Suspended or Revoked*

Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Has any license, permit or privilege ever been suspended or revoked?

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Suspended or Revoked

Please explain:

Operate a Motor Vehicle

Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?

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Disqualified for Violations*

If yes, provide details

Driving Experience

Have you operated any of the following: Straight Truck, Tractor or Semi-Trailer, or Commerical Van? If yes, please state when and for how many approximate miles did you drive for. Did you take any special courses or training that will help you as a driver?

Accident History*

Accident review for the past 3 years. Please include Nature of Accident, # Fatalities, # Injuries, # Vehicles Towed, any Citations Issued:

Motor Vehicle Driving Record (MVR)*

Please list any Traffic Convictions and Forfeitures for the past 3 years other than parking violations.

Employment Record*

Please list the two most recent employers

Job Title and Supervisor Name #1*

Employment Reference #1 Phone number*

Length of Time at Company #1

Employee Reason For leaving (#1)

Employment Reference #2*

Please list previous employer prior to current/last disclosed above.

Job Title and Supervisor Name #2*

Employment Reference #2 Phone Number*

Length of Time Company #2

Employee Reason for leaving (#2)

Signature of Applicant*

I certify that I have read and understand all of this employment application. It is agreed and understood that the employer or his agents may investigate the applicant's background to ascertain and and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and other persons name herein from liability for any damages on account of his furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate than I am capable of performing tasks that are pertinent to the job. It is also agreed and understood that the Fair Credit Reporting Act, Public Law 91-508, I have been told that his investigation may include an investigative Consumer Report, including information regarding my character, personal reputation, personal characteristics and mode of living. I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal. If hired, I agree to abide by all the rules and policies of the employer. 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.

Additional Applicant Comments

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