Employment Application Form

If you are interested in driving for Great Lakes HR Solutions, LLC please complete the form below.

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-related disability.

Requirements for our drivers include:
* At least 2 years of recent driving experience
* No careless or reckless driving citations
* No OUI/DWI or open container citations
* No more than 4 points

Name: * First Last
Please enter your full name
Position: *
Date of Birth: * / MM / DD YYYY
Social Security Number: *
Address: *
Street Address

City

State

Zip
Phone Number: * - (###) - ### ####
Alternate Number: - (###) - ### ####
Email:
Can you provide proof of age? * Yes No
Are you at Least 23 years old? * Yes No
Have you driven in the last 18 months? * Yes No
Do you have the legal right to work in the United States? * Yes No
How did you hear about Great Lakes HR Solutions?
License Information:
Drivers License #: *
Exp. Date: * / MM / DD YYYY
State: *
Type: *
Endorsements:
Can you drive in Canada? * Yes No
Do you have a FAST (free and secure trade program) driver card? * Yes No
Have you ever been denied a license, permit or privilege to operate a motor vehicle? * Yes No
If yes, please explain:
Has any license, permit or privilege ever been suspended or revoked? * Yes No
If yes, please explain:
Have you been convicted of any of the following?
(check all that apply)
Careless Driving: * Yes No
If yes, please explain:
Reckless Driving: * Yes No
If yes, please explain:
OUI * Yes No
If yes, please explain:
DWI * Yes No
If yes, please explain:
How many years of commercial driving experience do you have? *
Last time you drove a commercial vehicle: * / MM / DD YYYY
Points on license: *
Have you ever been convicted of a felony? * Yes No
If yes, please explain:
Have you ever been convicted of a misdemeanor? * Yes No
If yes, please explain:
Is there any reason you might be unable to perform the functions of the job for which you have applied? (as described to you) * Yes No
If yes, please explain:
Indication of a criminal record would require for you to provide your own Fidelity Bonding Coverage

Availability:
How soon are you able to work? * / MM / DD YYYY
Hours desired: *
Shifts desired: *
Are you able to work other hours/shifts if the desired are not available? * Yes No
Accident record for past 3 years:
Date of Accident: / MM / DD YYYY
Explain Nature of Accident:
Date of Accident: / MM / DD YYYY
Explain Nature of Accident:
Date of Accident: / MM / DD YYYY
Explain Nature of Accident:
Education:
Highest grade completed in High School * 9th 10th 11th 12th
College 1-2 yrs 2-4 yrs 5 + yrs
Last School Attended: *
City:
_
Additional Information for Driver Application:

ADDRESS HISTORY FOR THREE YEARS
Address
Street Address

City

State

Zip
How long?
Address
Street Address

City

State

Zip
How long?
Address
Street Address

City

State

Zip
How long?
_
Employer History:

All driver applicants that drive interstate commerce must provide the following information for all employers during the last three years. Applicants that drive commercial motor vehicles in intrastate or interstate commerce shall provide an additional 7 years information on those employers for whom the applicant operated such vehicle.

(Note: List employer in reverse order starting with the most recent)
Name of Employer #1: *
Street Address

City

State

Zip
Contact Person: *
Phone * - (###) - ### ####
Salary/Wages: *
Position Held: *
Reason for leaving: *
Date Started: * / MM / DD YYYY
Date Ended: / MM / DD YYYY
Name of Employer #2: *
Street Address

City

State

Zip
Contact Person: *
Phone * - (###) - ### ####
Salary/Wages *
Position Held: *
Reason for leaving: *
Date Started: * / MM / DD YYYY
Date Ended: * / MM / DD YYYY
Name of Employer #3: *
Street Address

City

State

Zip
Contact Person: *
Phone: * - (###) - ### ####
Salary/Wages: *
Position Held: *
Reason for leaving: *
Date Started: * / MM / DD YYYY
Date Ended: * / MM / DD YYYY
Name of Employer #4:
Street Address

City

State

Zip
Contact Person:
Phone: - (###) - ### ####
Salary/Wages:
Position Held:
Reason for leaving:
Date Started: / MM / DD YYYY
Date Ended: / MM / DD YYYY
Name of Employer #5:
Street Address

City

State

Zip
Contact Person:
Phone: - (###) - ### ####
Salary/Wages:
Position Held:
Reason for leaving:
Date Started: / MM / DD YYYY
Date Ended: / MM / DD YYYY
Name of Employer #6:
Street Address

City

State

Zip
Contact Person:
Phone: - (###) - ### ####
Salary/Wages:
Position Held:
Reason for leaving:
Date Started: / MM / DD YYYY
Date Ended: / MM / DD YYYY
Name of Employer #7:
Street Address

City

State

Zip
Contact Person:
Phone: - (###) - ### ####
Salary/Wages:
Position Held:
Reason for leaving:
Date Started: / MM / DD YYYY
Date Ended: / MM / DD YYYY
Name of Employer #8:
Street Address

City

State

Zip
Contact Person:
Phone: - (###) - ### ####
Salary/Wages:
Position Held:
Reason for leaving:
Date Started: / MM / DD YYYY
Date Ended: / MM / DD YYYY
Experience and Qualifications:
List States operated in for last five years: *
Which safe driving certificates do you hold and from whom:
List any other training you've acquired that may be relevant:
List any other experience or skills that may be relevant:
TO BE READ AND AGREED BY APPLICANT
This certifies that I completed this application, that all entries and information are true and completed 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 a conditional offer or 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.

In the event of employment, I understand that false or misleading information given in my application or interview's may result in discharge. I also understand that I am required to abide by all rules and regulations of this company.

By submitting this application you accept these terms and conditions.

Once you press CONTINUE, please review the information and make any changes and print a copy for your records (using your browser's print button).

Employment Application Form

Employment Application Form

License Information:

Have you been convicted of any of the following?
(check all that apply)

Indication of a criminal record would require for you to provide your own Fidelity Bonding Coverage

Availability:

Accident record for past 3 years:

Education:

_

Additional Information for Driver Application:

ADDRESS HISTORY FOR THREE YEARS

_

Experience and Qualifications:

TO BE READ AND AGREED BY APPLICANT

Employment Application Form