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Employment Application
Required fields are marked with a star (*) in green. We Thank You for taking time out to fill out the application.

* First Name
Middle
* Last Name
* Address
Apt. #

* City
*State
* Zip
*Phone
* Date of Birth
*Social Security#
 
E-mail Address
* How did you hear about us?

* Position applying for:

Mandatory if Owner Operator  Year / Make of previous truck
* Driver's License Number
*State
* License Expiration Date
CDL?
* Endorsements?
* No. of Tickets last 3 years
   
* No. of accidents last 3 years
   
* DUI?
If yes, when
* License suspended or revoked?
If yes, when
* Convicted of a felony or misdemeanor?
If yes, when

* Employment History 1
*From
*To
*Employer's Name
*Address
*City
*State
Phone
*Position
*# of accidents
*Type of Trailer
*# of States
Reason for leaving

* Employment History 2
*From
*To
*Employer's Name
*Address
*City
*State
Phone
*Position
*# of accidents
*Type of Trailer
*# of States
Reason for leaving

* Employment History 3
*From
*To
*Employer's Name
*Address
*City
*State
Phone
*Position
*# of accidents
*Type of Trailer
*# of States
Reason for leaving
 
*** Please Read Carefully. By Clicking The Submit Button, you agree to the following:
I certify that I personally completed this application and that all of the information is true and correct. I hereby request and authorize H&O to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed this application of my own free will and hold H&O harmless of all liability for providing this application for my use.

In connection with my application for certification (including contract for services) with you, I understand that consumer reports which may contain public record information may be requested from H&O Transport. These reports may include the following type of information: names and dates of previous employers, reason for termination of employment, work experience, accidents, etc. I further understand that such reports may contain public record information concerning my driving record, workers compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records; as well as information from H&O concerning previous driving record requests made by others from such state agencies, and state provided driving records.

I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY H&O TO FURNISH THE ABOVE-MENTIONED INFORMATION.

I have the right to make a request to H&O, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me which H&O has previously furnished within the two year period preceding my request. I hereby consent to your obtaining the above information from H&O, and I agree that such information which H&O has or obtains, and my employment history with you if I am hired, will be supplied by H&O to other companies which subscribe to H&O Services.

I hereby authorize procurement of consumer report(s). If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment (or contract) period.

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