The mission of KSI is to create opportunities for individuals with disabilities
to learn and grow. Through training, education and supportive programs and services, we
enable individuals to accomplish their personal and work-related goals.
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Driver Employment Application
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Application Information
*
Position Applied For
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First Name
*
Last Name
*
Address
*
City
*
State/Province
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Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
*
Postal Code
*
Phone
Email Address
Desired Salary
Are you a citizen of the United States?
Yes
No
If no, are you authorized to work in the U.S?
Yes
No
Do you know anyone who works for this company?
Yes
No
If yes, who?
Have you ever worked for this company?
Yes
No
If yes, when?
How did you hear about this position?
Do you have a Delaware drivers license?
Yes
No
DL # -
State
Education
High School
Address
From - To
Did you graduate?
Yes
No
Diploma
College
Address
From - To
Did you graduate?
Yes
No
Degree
References
Please list three professional or personal references.
Full Name
Relationship
Company
Phone Number
Address
Full Name
Relationship
Company
Phone Number
Address
Full Name
Relationship
Company
Phone Number
Address
Previous Employment
Company
Phone
Address
Supervisor
Job Title
Responsibilities
From - To
Reason For Leaving
Did you drive a CDL required vehicle?
Yes
No
May we contact your previous supervisor for a reference?
Yes
No
Company
Phone
Address
Supervisor
Job Title
Responsibilities
From - To
Reason For Leaving
Did you drive a CDL required vehicle?
Yes
No
May we contact your previous supervisor for a reference?
Yes
No
Military Service
Branch
From - To
Rank At Discharge
Type of Discharge
Signature
Accident Record for Past 3 Years or More
Last Accident Date
Nature of Accident
Fatalities?
Yes
No
Injuries?
Yes
No
Previous Accident #2 Date
Nature of Accident
Fatalities?
Yes
No
Injuries?
Yes
No
Previous Accident #3 Date
Nature of Accident
Fatalities?
Yes
No
Injuries?
Yes
No
Traffic Convictions and Forfeitures for the Past 3 Years (Other than parking violations)
Location
Date
Charge
Penalty
Location
Date
Charge
Penalty
Location
Date
Charge
Penalty
Driver Licenses
State
License Number
Type
Expiration Date
State
License Number
Type
Expiration Date
State
License Number
Type
Expiration Date
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Yes
No
Has any license, permit or privilege ever been suspended or revoked?
Yes
No
If the answer to either question is Yes, please give details
Driving Experience
Straight Truck
Tractor & Semi-Trailer
Tractor-Two Trailers
Motorcoach-School Bus
Other
Approximate Number of Miles Total
List States Operated in for Past 5 Years
Describe any special training that will help you as a Driver
Which safe driving awards to do you hold, and from whom?
List any trucking or other experience that may help you in your work for KSI
List any courses and training other than already shown elsewhere in this application
List special equipment or technical materials you can work with (other than listed elsewhere)
KSI Employment
KSI provides equal employment opportunities to all employees and applicants for employment. F/M/Vet/Disabled/Sexual Orientation/Gender Identity
Disclaimer and Signature
I expressly authorize, without reservation, Kent-Sussex Industries, Inc. herein after known as “the employer”, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, addendum(s), resume or job interview. I hereby waive any and all rights and claims may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's CEO. I certify that all information that I have provided in order to apply for and secure work with this employer is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to eliminate me from further consideration for employment, or may result in my immediate termination from the employer’s service, whenever it is discovered.
Signature
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