D.M.T. Services, Inc.
Application for Employment
Please Note:
If you have a resume you would
like to send instead of filling this out, then please email
to hr@dmtservicesinc.com
This application form was designed for
use by persons applying for various types of positions --
clerical, professional, technical, and administrative. Please
answer the questions to the best of your ability. All
information will be treated confidentially.
ALCOHOL & DRUG TESTING
REQUIRED.
*** Applicants Must Live Within A 60
Mile Radius Of
Siloam Springs, AR or Ft. Smith, AR
***
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How were you referred to us?
Name of referral source:
TYPE OF WORK DESIRED
Indicate the position for
which you are applying:
Do you
wish to work:
If part time, specify hours or days:
What is your minimum weekly salary
requirement?
Mileage
Requirement?
Date available
for work:
Do you have any commitments to
another employer that might affect your employment with us?
NOTICE
Answer all questions
that apply to you and the job you are applying
for.
EDUCATIONAL DATA
MILITARY EXPERIENCE
Were you in the U.S. Armed Forces?
Yes
No If
yes, what branch?
Dates of duty:
From: To: Rank at Seperation:
Briefly describe your duties:
EMPLOYMENT HISTORY |
Any person applying for a job as a
commercial vehicle driver must inform the prospective employer
of all previous employment as the driver of a commercial
vehicle for the past 10 years, in addition to any other
required information about the applicant's employment
history. |
List present
employer or most recent employer first (use the text field following
the first four entries if necessary).
May we contact these
employers?
Yes
No
EXPERIENCE AND QUALIFICATIONS -- CLERICAL
List
courses and training in office work:
*Indicate Words Per Minute
EXPERIENCE AND QUALIFICATIONS -- MAINTENANCE
List courses and training in maintenance work:
EXPERIENCE AND QUALIFICATIONS -- PLATFORM
List
types of platform experience and years of each:
List platform equipment you can operate (lift truck, etc.):
Show courses or training in platform work:
EXPERIENCE AND QUALIFICATIONS -- DRIVER
(Answer only if
applying for driving position)
Date of Birth:
A. Have you ever been denied a license, permit, or privilege to
operate a motor vehicle?
Yes
No
B. Has any license, permit, or privilege
ever been suspended or revoked?
Yes
No
C. Have you ever been disqualified
subject to section 391 of the Federal Motor Carrier Safety
Regulations?
Yes
No
If the
answer to either A, B, or C is yes, please give details:
DRIVING EXPERIENCE
List states operated in for the last five years:
Show special courses or training that will help you as a
driver:
Which safe driving awards do you hold and from whom?:
ACCIDENT REVIEW FOR PAST 3 YEARS
Traffic convictions and forfeitures for the past 3 years
(other than parking violations):
Date of last DOT Physical Examination:
I
hereby authorize release of any driving record to D.M.T. Services,
Inc. This is for employment purposes on a "new hire" and shall
include all convictions on my record from all states.
GENERAL INFORMATION
Are you a U.S.
Citizen?
Yes
No
If no, what type of
visa do you hold?
Are you
willing to undergo a pre-employment physical exam?
Yes
No
Have you ever been convicted of a
criminal offense?
Yes
No
Nature:
(An affirmative answer will not automatically disqualify you
from being considered as a candidate for employment.)
Have
you previously applied for employment here?
Yes
No
If yes, when?
Are any of your relatives employed here?
Yes
No
If yes, please list
name and department:
REFERENCES (Not employers or relatives -- At least
three)
Person to be notified in case of Emergency:
Please include any other information you think would be helpful
to us in considering you for employment, such as additional work
experience, articles/books published, activities, accomplishments,
etc. (You may exclude all information indicative of age, sex, race,
religion, color, national origin, or handicap.)
RELEASE FOR ALL
RECORDS
I hereby authorize your
company/organization to release to D.M.T. Services, Inc. all
records of my employment, including assessments of my job
performance, all records of controlled substance and alcohol
testing, and ability and fitness which may be requested in
connection with my application for employment with them. I
hereby release your company/organization from any and all
liability of any type as a result of providing above mentioned
information to D.M.T. Services, Inc.
DRIVER RELEASE
In
connection with my application for employment with you, I
understand that an investigative consumer report is being
requested from DAC Services, Tulsa, Oklahoma, that will
include information as to my character, work habits,
performance and experience, along with reasons for termination
of past employment obtained from previous employers. Further,
I understand that you will be requesting information
concerning my driving record and/or information from various
state agencies which maintain records concerning traffic
offenses, accidents, etc. as well as information from DAC
concerning (1) previous driving record requests made by others
from such state agencies and (2) claims involving me in the
files of insurance companies. I have a right to make a written
request within a reasonable period of time to receive
additional detailed information about the nature and scope of
this investigation. I hereby consent to your obtaining the
above-described information from DAC, and agree that such
information which DAC has or obtains, and my employment
history with you if I am hired, will be supplied by DAC to
other companies which subscribe to DAC's services.
IF
HIRED BY YOU, I FURTHER CONSENT TO YOUR FURNISHING TO DAC
INFORMATION CONCERNING MY CHARACTER, WORK HABITS, PERFORMANCE,
DRIVING RECORD AND EXPERIENCE, AS WELL AS ANY REASONS FOR
TERMINATION OF MY EMPLOYMENT, AND FURTHER CONSENT TO DAC'S
FURNISHING SUCH INFORMATION IN THE FUTURE TO OTHER COMPANIES
WHICH SUBSCRIBE TO DAC'S SERVICES FROM WHICH I MAY BE SEEKING
EMPLOYMENT, AND TO INSURANCE COMPANIES OR THEIR AGENTS IN
CONNECTION WITH ISSUANCE OR MAINTENANCE OF INSURANCE
COVERAGE.
I understand that my employment can be terminated,
with or without cause, at any time at the discretion of either
the company or myself. I understand that no management
official other than the president of the company has any
authority to enter into any agreement contrary to the forgoing
or make any oral assurance or promise of continued
employment.
I authorize persons, schools, my current
employer (if applicable), and previous employers and
organizations named in this application (and accompanying
resume, if any) to provide any relevant information that may
be required to arrive at an employment decision.
This
certifies that this application was completed by me, and that
all entries on it and information in it are true and complete
to the best of my knowledge.
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