APPLICATION FOR EMPLOYMENT

LIEN TRANSPORTATION COMPANY
PO BOX 40
ABERDEEN, SD 57401
PHONE 605-225-3814 EXT #11
Positions Applied For:
Name:
Address:
City: State: Zip:
Telephone Number(s):
Social Security Number:
If necessary, best time to call you at home:
Have you ever been employed here before?
If yes, give date: From: To:
Are you legally eligible for employment in this county?
(Proof of U.S. Citizenship or immigration status will be required upon employment)
Are you presently employed?
Date available for work:
Have you ever been convicted of a felony in the last seven (7) years?
(Such conviction may be relevant if job related, but does not bar you from employment)
If yes, please explain:
Do you have a valid driver's license? State:
Driver's License Number:
EDUCATION
School/College
Address/Telephone
Years completed
School/College
Address/Telephone
Years completed
REFERENCES
List name and telephone number of three business work references who are not related to you.
Name
Telephone number
Years known
Name
Telephone number
Years known
Name
Telephone number
Years known
SKILLS AND QUALIFICATIONS – Summarize any special training skills, licenses, certificates, machinery/equipment operated and/or characteristics of yourself that may qualify you as being able to perform job-related functions for the position which you are applying.
EMPLOYMENT HISTORY – List the last three (3) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in the comments section below.
Employer:
Address:
Telephone:
Dates: From: To:
Immediate Supervisor and Title:
Wage:
Job title/Duties
Reason for leaving
May we contact for reference? YesNo
Employer:
Address:
Telephone:
Dates: From: To:
Immediate Supervisor and Title:
Wage:
Job title/Duties
Reason for leaving
May we contact for reference? YesNo
Employer:
Address:
Telephone:
Dates: From:To:
Immediate Supervisor and Title:
Wage:
Job title/Duties
Reason for leaving
May we contact for reference? YesNo
CDL INQUIRY ONLY– If you do not have a CDL license, skip this part.
Class:
Expiration Date:
Do you have a health card YesNo
DRIVING EXPERIENCE
Class of Equipment
Type (van, truck, etc)
Dates From: To:
Approx. Miles
Class of Equipment
Type (van, truck, etc)
Dates From: To:
Approximate Miles
Class of Equipment
Type (van, truck, etc)
Dates From:To:
Approximate Miles
Class of Equipment
Type (van, truck, etc)
Dates From: To:
Approximate Miles
Date of last accident
Nature of accident
Number of fatalities
Number of persons injured
Date of next previous accident
Nature of accident
Number of fatalities
Number of persons injured
Date of next previous accident
Nature of accident
Number of fatalities
Number of persons injured
TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (other than parking tickets)
State
Date
Charge
Penalty
State
Date
Charge
Penalty
State
Date
Charge
Penalty
A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?Yes No
B. Has any license, permit of privilege ever been suspended or revoked? Yes No
IF THE ANSWER TO EITHER A OR B IS YES, EXPLAIN DETAILS BELOW.
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Lien Transportation Company • PO Box 40 • Aberdeen, South Dakota 57402
Phone: 605-225-3814 • Fax: 605-225-4707
©2002 Lien Transportation Company