Apply Online - Kolnik Trucking, Inc., Kolnik Distribution, Inc

Personal Information

First Name:*

Middle Name:

Last Name:*

Cell Phone Number:

Home Phone Number:*

Have You Ever Been Convicted of a Felony?*

Yes
No

Please Explain Conviction of Crime:*

Who Referred You:

Rate of Pay Expected:*

Are You Currently Employed?

Yes
No

How Long Since Leaving Employment?*

Addresses (Past 3 Years)

Addresses:

Street Address:	City:	State:	Zip:	Actions

There are no Addresses.

Education

Have you completed any years of college?*

Yes
No

Highest year completed:*

School/College Name:*

Address:*

City:*

State:*

Zip:*

Military Experience

Have you ever served in the U.S. Armed Forces?*

Yes
No

Which branch of service?*

Describe any military training received relevant to the position for which you are applying:*

Company Bonding

Have you ever been bonded?

Yes
No

Name of bonding company:*

Kolnik Employment

Have you every worked for Kolnik?*

Yes
No

Position:*

Rate of Pay:*

From:*

To:*

Reason for Leaving:*

Names of any Relatives Employed by Kolnik:

Employment Record

The Federal Motor Carrier Safety Regulations (49CFR391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last 3 years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional 7 years of a total of 10 years. Any gaps in employment must be explained. Start with the LAST or CURRENT position, including any military experience, and work back. You are required to list the complete mailing address: street number, city, state and zip code.

Past Employment:

Employer:	Supervisor’s Name:	City:	Actions

There are no Employers.

Applicant’s Signature Requested

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 any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and other persons named herein from all 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 that I am capable of performing tasks that are pertinent to the job.

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, 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.

First Name:*

Last Name:*

Request for Past Employment Verification Information fromu0003 Previous Employer(s)

First Name:*

Last Name:*

Social Security Number:*

Date of Birth:*

Applicant’s Signature Requested

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. I hereby give my permission for you to retrieve my Motor Vehicle Record from the state it is issued by and also retrieve all my records from Pre-employment Screening Program (PSP).

In the event of employment, I understand that false or misleading information given in my application or interviews may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Kolnik Trucking Inc.

I understand information I provide regarding current and/or previous employers may be used, and those employers will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23 (d) and (e). I understand that I have the right to:

Review information provided by the previous employers;
Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

This certifies 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.

First Name:*

Last Name:*

General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse

I hereby provide consent to Kolnik Trucking, Inc. to conduct a limited query of the FMCSA -Commercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse. This consent form is valid for the duration of my employment and will only be cancelled upon termination. I understand that if the limited query conducted by Kolnik Trucking, Inc. indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Kolnik Trucking, Inc. without first obtaining additional specific consent from me. I further understand that if I refuse to provide consent for Kolnik Trucking, Inc. to conduct a limited query of the Clearinghouse, Kolnik Trucking, Inc. must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.

First Name:*

Last Name:*

Signature

Date

Warehouse Associate

Personal Information

Addresses (Past 3 Years)

Education

Military Experience

Company Bonding

Kolnik Employment

Employment Record

Applicant’s Signature Requested

Request for Past Employment Verification Information fromu0003 Previous Employer(s)

Applicant’s Signature Requested

General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse