Application Form

Great Bay Distributors

Online Application for Employment

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Candidates will be required to pass a pre-employment drug test. Great Bay Distributors is an equal opportunity employer, complying with all laws prohibiting discrimination due to race, color, religion, sex, national origin, age, handicap, disability, marital and veteran status; all applications are welcome. Great Bay will also take all necessary steps to reasonably accommodate individuals who have a handicap, disability, or bona fide religious belief. Please answer all questions. Resumes are not accepted in lieu of completion of this application. Applications are only valid for 30 days.

Job Application

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Full Name

SS#

Address

State and Zip Code

Email Address

Phone

Where did you hear about the Position?

Only U.S. citizens or aliens who have a legal right to work in the U.S. are eligible for employment. Can you, upon employment, submit documentation verifying your legal right to work and your identity? *

Have you ever been convicted of any crime? *

Are you over the age of 18? *

Education

High School name & address *

Grade/Years Completed *

Diploma

College/University name & address Grade/Years Completed Diploma/Degrees Describe course of study Describe specialized training, apprenticeship, skills, and extracurricular activities Honors received

Have you had prior job educational experience which relates to the job for which you are applying? - If yes, explain.

General Info

Have you taken any illegal drugs in the last 30 days? *

Are you a veteran of the U.S. Military Service? *

Have you applied here before? *

To be completed by applicants requesting driving or sales positions

I understand that information I provide regarding current and/or previous employers may be used, and previous 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 previous employers; Have errors in the information corrected by previous employers and for those previous employers to re-send 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.

Drivers License #, State and Class

Have you had any tickets? - If yes, explain

Has your license ever been suspended or revoked? - If yes explain

Do you have any DUI or DWI convictions? - If yes explain

Driving Experience

Straight Truck

Type of Vehicle Date (From) Date (To) Aprox. Miles

Tractor/Semi-Trailer

Type of Vehicle Date (From) Date (To) Aprox. Miles

Tractor/Two Trailer

Type of Vehicle Date (From) Date (To) Aprox. Miles

Tractor/Three Trailer

Type of Vehicle Date (From) Date (To) Aprox. Miles

Work Commitment

Will you work overtime if asked?

Are there any hours, shifts or days you will not work? - If yes, explain

Do you have any friends, relatives who work here? - If yes please specify

Are you now employed?

May we contact them?

Are you on a layoff?

Are you subject to recall?

Work History (Please list most recent job first)

Account for all time periods including unemployment, self-employment and military service.

Employer 1

Employer 2

Employer 3

Employer 4

Please explain any gaps in your employment history:

Have you ever been forced to resign? - If yes, explain

Did you receive any discipline in the last 12 months of active employment? - If yes, explain

Were you given a performance evaluation within the last 12 months of active employment? - If yes, what was the range of scores used and what was your score:

Have you ever signed any non-compete agreement with any other employer that would restrict you from working with this company ?- If yes, explain

Salary requested

Date you can start

Character references: List 3 persons not related to you, whom you have known at least 1 year.

1) Name, address and phone#

Occupation

2) Name, address and phone#

Occupation

3) Name, address and phone#

Occupation

List below any information/remarks you wish to have considered as a part of your application

I certify that the answers given by me to the above questions and statements are true and correct and hereby authorize you to contact references, past or present employers, persons, schools, law enforcement agencies and any other sources of information which may be relevant to my application for employment. It is understood and agreed that any misrepresentation, false statement or omissions by me in the application be will sufficient reason for rejection of my application or for dismissal at any time during my employment, without liability to this company. I have read, understand and agree to the above statement.

I further understand that no representative of the company has the authority to enter into any agreement for employment for any special period of time and that this company is not guarantying employment for anyone. No employment contract is created by virtue of my being hired by the company. I have read, understand and agree to the above statement.

If employed, I agree to abide by all the work and safety rules of the Company. I understand that this company is committed to maintaining a drug free workplace. I am aware that the company may require a drug test as part of the hiring process. Also, if employed, I fully realize that the company conducts annual random drug testing of its employees. I have read, understand and agree to the above statement.

I understand that this application will remain on file for 30 days consideration. After 30 days, if I am still interested in a position with this company, it will be necessary for me to complete a new application form.

In lieu of signature, please type please type initials here

In lieu of signature, please type full name *

Please type full date (mm/dd/yyyy) *

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