Witmer's Feed & Grain | DOT Employment Application

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.

Today's Date*

Personal Information

First Name*

Last Name*

Email*

Phone No.*

Date of Birth

Driver’s License No.

Issuing State

SSN No.

Current Address

Address*

City*

State*

Zip Code*

Previous Address(es)

Address

City

State

Zip Code

Address

City

State

Zip Code

Education

High School

High School Name

Full Address

Years

Graduated?

Yes No

Major

College/Trade School

High School Name

Full Address

Years

Graduated?

Yes No

Major

Other School

High School Name

Full Address

Years

Graduated?

Yes No

Major

Traffic Violations & Forfeitures

Location

Date

Cause/Charge

Penalty

Location

Date

Cause/Charge

Penalty

Location

Date

Cause/Charge

Penalty

If more, list them here

OTHER EXPERIENCE AND QUALIFICATIONS

Show any trucking, transportation or other experience that may help in your work for Witmer’s Feed.

List Courses and training other than shown elsewhere in this application.

List special equipment or technical materials you can work with (other than those already shown).

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:

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

PERSONAL STATEMENTS

Do you have any agriculture background or experience? If so, please list

What skills or work experience do you have? Please list

Please state why you would be an asset to Witmer’s Feed & Grain as an employee

TO BE READ AND AUTHORIZED BY APPLICANT

By checking the boxes below you agree to the following:

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

Under the provisions of the Fair Credit Reporting Act, 15 UFC, SECTION 1681 ET SEQ, The Americans with Disabilities Act and all applicable Federal, State, and Local laws, I hereby authorize and permit Witmer’s Feed and Grain, Inc. to obtain a consumer report and/or an investigative consumer report which may include the following: (1) My Employment Records; (2) Records concerning any driving, criminal history, credit history, civil records, Worker’s Compensation and drug testing; (3) (For Truck Drivers Only) In accordance with the Department of Transportation Motor Carrier Safety Regulations, Section 382.413, information concerning alcohol and controlled substances for the last 3 years; (4) Verification of my academic and/or professional credentials; and information and/or copies of documents from any military service records.

I understand that an ‘Investigative Consumer Report’ may include information as to my character, general reputation, personal characteristics, and mode of living which may be obtained by interviews with individuals with whom I am acquainted or who may have knowledge concerning any such items of information. I agree that a copy of the authorization has the same effect as an original. I hereby release and hold harmless any person, firm, or entity that discloses matters in accordance with this authorization, as well as Witmer’s Feed & Grain, Inc., from liability that might otherwise result from the request for use and/or disclosure of any or all of the foregoing information.

I understand and acknowledge that under provision of the Fair Credit Reporting Act I may request a copy of any consumer report from the consumer reporting agency that complied report, after I have provided proper identification. I hereby authorize Witmer’s Feed & Grain, Inc., to obtain and prepare an investigative consumer report as set forth above, as part of its investigation of my employment application. This authorization shall remain in effect over the course of my employment. Reports may be ordered periodically during the course of my employment.

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.

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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

Current Employer

Previous Employer

Previous Employer

Previous Employer

Previous Employer

PERSONAL STATEMENTS

TO BE READ AND AUTHORIZED BY APPLICANT

Disclosure

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DOT Employment Application

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

Current Employer

Previous Employer

Previous Employer

Previous Employer

Previous Employer

PERSONAL STATEMENTS

TO BE READ AND AUTHORIZED BY APPLICANT

Disclosure

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