Harty Tractor Services Employment Application

A copy of your driver license and social security card will be needed if hired.

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, or non-job related disability.

    Position(s) applied for *

    Name (Last, First Middle Initial) *

    Social Security Number

    Email *

    Telephone No. *

    Alternate Telephone No.

    Current Address (Street, City, State and Zip Code) *

    Length at Current Address *

    Previous Address (Street, City, State and Zip Code)

    Length at Previous Address

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

    Date of Birth (month, day, year) *

    Can you provide proof of age? *

    Have you worked for Harty Tractor before? *

    Date From

    Date To

    Rate of Pay

    Position

    Reason for leaving

    Do you have any relatives working at Harty Tractor? *

    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 for which you have applied? *

     

    EMPLOYMENT HISTORY

    All driver applicants to drive in interstate commerce must provide the following information on all employers during the proceeding 3 years. List complete mailing address, street number, city, state and zip code.

    Applicants to drive a commercial motor vehicle* (including vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers or any size vehicle used to transport hazardous materials in quantity requiring placarding), in interstate or interstate commerce shall also provide an additional materials in quantity requiring placarding), in interstate or interstate commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such vehicle.

    (NOTE: List employers in reverse order starting with the most recent. An additional text box is at the bottom of form, if additional space is needed.)

    Name *

    Address *

    City *

    State *

    Zip *

    Contact Person *

    Contact Phone Number *

    Date Started (month & year) *

    Date Ended (month & year) *



    Name

    Address

    City

    State

    Zip

    Contact Person

    Contact Phone Number

    Date Started (month & year)

    Date Ended (month & year)



    Name

    Address

    City

    State

    Zip

    Contact Person

    Contact Phone Number

    Date Started (month & year)

    Date Ended (month & year)



    Name

    Address

    City

    State

    Zip

    Contact Person

    Contact Phone Number

    Date Started (month & year)

    Date Ended (month & year)

     

    Accident record for past 3 years or more. (An additional text box is at the bottom of form, if additional space is needed.) If none, write none.


    Last Accident

    Date

    Nature of Accident (head-on, rear-end, upset, etc.)

    Fatalities

    Injuries



    Date

    Nature of Accident (head-on, rear-end, upset, etc.)

    Fatalities

    Injuries



    Date

    Nature of Accident (head-on, rear-end, upset, etc.)

    Fatalities

    Injuries

     

    Traffic convictions and forfeitures for the past 3 years (other than parking violations) (An additional text box is at the bottom of form, if additional space is needed.) If none, write none.


    Location

    Date

    Charge

    Penalty



    Location

    Date

    Charge

    Penalty



    Location

    Date

    Charge

    Penalty

     

    EDUCATION

    Completed *

    Last School Attended (Name and City, State) *

     

    EXPERIENCE AND QUALIFICATIONS - DRIVER

    Driver Licenses

    State *

    License No. *

    Type *

    Expiration Date *



    State

    License No.

    Type

    Expiration Date



    State

    License No.

    Type

    Expiration Date

    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? *

     
    Driving Experience

    Straight Truck *

    Type of Equipment (Van, Tank, Flat, etc.)

    Date From

    Date To

    Approx. No. of Miles (Total)

    Tractor & Semi-Trailer *

    Type of Equipment (Van, Tank, Flat, etc.)

    Date From

    Date To

    Approx. No. of Miles (Total)

    Tractor - Two Trailers *

    Type of Equipment (Van, Tank, Flat, etc.)

    Date From

    Date To

    Approx. No. of Miles (Total)

    Motorcoach - School Bus *

    Type of Equipment (Van, Tank, Flat, etc.)

    Date From

    Date To

    Approx. No. of Miles (Total)

    Other *

    Type of Equipment (Van, Tank, Flat, etc.)

    Date From

    Date To

    Approx. No. of Miles (Total)

    List states operated in the last five years.

    Show special courses or training that will help you as a driver.

    Which safe driving awards do you hold and from whom?

     

    EXPERIENCE AND QUALIFICATIONS - OTHER

    Show any trucking, transportation or other experiences that may help in your work for this company.

    List courses and training other than shown elsewhere in this application.

    List special equipment or technical materials you can work with (other than those already shown).

     

    List additional employment history, accident record, and/or traffic convictions, if extra space is needed.

    To Be Read and Signed by Applicant

    This 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. I authorize you 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. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended). I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. We require you to sign the following documents when you submit your application.

    Fair Credit Reporting Act and authorization to obtain reports such as your driving record for assessment of insurability.

    Date *

    Applicant's Signature *