Witmer’s Feed and Grain, Inc., is an equal opportunity employer. In compliance with Federal and State Equal Employment Laws, qualified applicants are considered for all positions without regard to race, color, religion, national origin, sex, age, marital status, veteran status, non-job related physical or mental disability or any other protected group.

Personal Information

Current Address
Previous Address(es)

QUESTIONNAIRE

Education

High School
College/Trade School
Other School

Driving History

Traffic Violations & Forfeitures

OTHER EXPERIENCE AND QUALIFICATIONS

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code.

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an addition 7 years’ information on those employers for whom the applicant operated such vehicle. (Note: List employers in reverse order starting with the most recent. Add another sheet if necessary).

** Include vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

+ The Federal Motor Carrier Safety Regulations (FMCRS) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle:

  1. Weighs or has a GVWR of 10,001 pounds or more
  2. Is designed or used to transport more than 8 passengers (including the driver)
  3. Is of any size and is used to transport hazardous materials in a quantity requiring placarding.
Current Employer
Previous Employer
Previous Employer
Previous Employer
Previous Employer

PERSONAL STATEMENTS

TO BE READ AND AUTHORIZED BY APPLICANT

By checking the boxes below you agree to the following:

Disclosure
As part of our hiring background and investigation, we may obtain consumer reports to prepare an investigative consumer report. The investigative consumer report may consist of contacting all listed prior employers to verify your employment history. It may also include, but not be limited to, credit information reports, criminal history reports and driving records. Under the provisions of the Fair Credit Reporting Act (15 USC at 1681-1681U) as amended, before we can seek such reports, we must have your written permission to obtain information. You have the right, upon written request, to a complete and accurate disclosure of the nature and scope of the investigation. You are also entitled to a copy of your rights under the Fair Credit and Reporting Act.