Buel, Inc.

P.O. Box 456

Chesnee, SC 29323

Carolinas-Northwest

PERSONAL DESCRIPTION            

 

Full Name  Phone No.

Date of Birth Social Security No.        

Current Street Address

City State   Zip  

In Case Of Emergency Notify at Phone Number

 

*If at the above residence for less than three (3) years, list below all residences for the past three (3) years.

Previous Address's

1) Street City

    State  Zip

2) StreetCity

     State Zip

3) StreetCity

     State Zip

Position Applying for:   Type of employment requested:

Who referred you / How did you find out about Buel Inc.?

Rate of Pay Expected

Names of any relatives employed at Buel Inc.

Are you currently employed? If not, how long since you were last employed?

If yes, when would you be available?

 Education                                                                                                           

 

Please Select last Grade Completed Graduated

College Graduated

Name of last school attended

Other Training

Are you prevented from lawful employment in this country because of your current

Immigration status?      

General                                                                                                                

Have you ever been bonded If Yes, Name of Bonding Company

Have you ever refused a DOT Drug or Alcohol Test?

In the past three (3) years, have you tested positive on a DOT Drug or Alcohol Test?

Have you ever been convicted of a Felony?

If Yes, please explain fully below. Conviction of a crime is not an automatic bar from employment. All circumstances will be considered.

Experience and Qualifications

Drivers License Number From

Expires

License Type (I.E. CDL Class A, Class 1,Ect.)

List CDL Endorsements

 

Have you ever been denied a permit, License, or privilege to operate

a commercial motor vehicle

Has your license permit or privilege been suspended or revoked?

 

Have you ever been disqualified for violations of the

Federal Motor Carriers Safety Regulations?

 

If you have answered YES to any of the above questions, please give details below.

 

  Driving Experienceence

 

Power Equipment Type of Equipment No. of Years States you have driven in
Straight Truck

 

Tractor Trailer Power Unit

Trailer

Bus School

Coach

 

 

Other (Specify)  

 

 

 Accident Record Last Three Years            

Nature of Accident (Overturn, Jack Knife, Rear End, Etc.) # of Fatalities # of Injuries Commercial Vehicle Personal Auto
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Traffic Convictions & Forfeitures Last Three Years (other than parking)  

State Date Charge Penality Commercial

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employment History History (for past 10 years, use separate sheet if necessary)

The US Department of Transportation requires that driver applications show

all employment for the past 10 (ten) years

*start with the last or current position, including military experience and work back.

Information should be complete including addresses and telephone numbers.

 

Failure to include accurate information will delay application processing.

 

Have you worked for this company before? When?

Position  Reason for Leaving

 

 

Last  / Current Employer:

 

Name of Company Phone No. ()

Street Address

City State   Zip  

From:  To:  Position

Supervisors Name :  Rate of Pay

Reason for Leaving

 

Previous Employer:

 

Name of Company Phone No. ()

Street Address

City State   Zip  

From:  To:  Position

Supervisors Name : Rate of Pay

Reason for Leaving

 

Previous Employer #2:

 

Name of Company Phone No. ()

Street Address

City State   Zip  

From:  To:  Position

Supervisors Name: Rate of Pay

Reason for Leaving

 

Previous Employer #3:

 

Name of Company Phone No. ()

Street Address

City State   Zip  

From:  To:  Position

Supervisors Name: Rate of Pay

Reason for Leaving

 

Previous Employer #4:

 

Name of Company Phone No. ()

Street Address

City State   Zip  

From:  To:  Position

Supervisors Name: Rate of Pay

Reason for Leaving

 

 

Previous Employer #5:

 

Name of Company Phone No. ()

Street Address

City State   Zip  

From:  To:  Position

Supervisors Name Rate of Pay

Reason for Leaving

 

Previous Employer #6:

 

Name of Company Phone No. ()

Street Address

City State   Zip  

From:  To:  Position

Supervisors Name: Rate of Pay

Reason for Leaving

 

Previous Employer #7:

 

Name of Company Phone No. ()

Street Address

City State   Zip  

From:  To:  Position

Supervisors Name: Rate of Pay

Reason for Leaving

 

Previous Employer #8:

 

Name of Company Phone No. ()

Street Address

City State   Zip  

From:  To:  Position

Supervisors Name : Rate of Pay

Reason for Leaving

 

 

 

MUST BE READ AND SIGNED BY APPLICANT    

By clicking "submit" I certify that I have read and understand all of this driver application. It is agreed and

understood that Buel Inc. or it's agents may investigate my background to ascertain any and all information of

concern, including driving records and criminal records, whether same is of record or not, and I release employers

and other persons named herin from all liability for any damages on account of furnishing such information.

I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am

capableof performing tasks which are pertinent to the job. I also understand that, as an applicant for a position

with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to

the job. I also understand that if offered a job, it may be conditional on the results of a physical examination and

a drug test.

 

I further certify that I am a genuine applicant for driver and this application is being submitted solely for the

purpose of contacting with Buel Inc. and for no other reason.

 

It is also agreed and understood that under the Fair Credit reporting Act, Public Law 91-508, I have been told that

this investigation may include an investigative Consumer report, including information regarding my character,

general 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 agree and understand that any misrepresentations of information given above shall be consideredan act of

falsification and may result in my rejection or dismissal.

 

If contracted, I agree to abide by all the rules and policies of Buel Inc.

 

By clicking on "SUBMIT"  I certify that this application was completed by myself and that all entries on it and

information in it are true and compete to the best of my knowledge.