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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 ***



First Name:
Last Name:
Federal D.O.T. regulations require you to list all residences held for the previous three years.
Address:
Address:
City:
State:
Zip:
Home Phone:
Business Phone:
Use this space for additional addresses:


How were you referred to us?

Newspaper Ad School On My Own
Current Employee Agency Other

Name of referral source:

TYPE OF WORK DESIRED

Indicate the position for which you are applying:

Do you wish to work:

Full Time Part Time Temporary

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

School
 Print Name, Number, Street, City, State and Zip Code for each School Listing No. of Years
Completed 		Degree, Major, or
Type of Course
High School
College
Graduate School
Trade, Bus., Night, or Corres.
Other

 

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

Employer:
Employed

From Mo./Yr:
To Mo./Yr:
 Supervisor's Name:
Address:
Telephone:

Your Job Title:

Your Salary
 Duties:
Start
End

Reason For Leaving:



Employer:
Employed

From Mo./Yr:
To Mo./Yr:
 Supervisor's Name:
Address:
Telephone:

Your Job Title:

Your Salary
 Duties:
Start
End

Reason For Leaving:



Employer:
Employed

From Mo./Yr:
To Mo./Yr:
Supervisor's Name:
Address:
Telephone:

Your Job Title:

Your Salary
 Duties:
Start
End

Reason For Leaving:



Employer:
Employed

From Mo./Yr:
To Mo./Yr:
 Supervisor's Name:
Address:
Telephone:

Your Job Title:

Your Salary
 Duties:
Start
End

Reason For Leaving:



EXPERIENCE AND QUALIFICATIONS -- CLERICAL

List courses and training in office work:


Indicate training and experience in the following:
Training
Years of
Experience
 
Training
Years of
Experience
Typing*
Accounting
Shorthand*
OS&D
Billing
Interline
Phone System
Claims
Key Punch Operator
Dispatcher
Calculator
Tabulator
Bookkeeping
Photo Copier
Windows Computer

Other

Microsoft Office (Word, Excel, Outlook)

Rates (indicate tariffs with which you have worked)

*Indicate Words Per Minute


EXPERIENCE AND QUALIFICATIONS -- MAINTENANCE


List courses and training in maintenance work:


Indicate training and experience in the following:

Training
Years of
Experience
Area
Training
Years of
Experience
Drive Line Components
Body Work
Diesel Engine Tune-up and Rebuild
Electrical Repair
Gas Engine Tune-up and Rebuild
Frame and Wheel Alignment
Tire Service
Brakes
Trailer Repair
Cooling System
Preventative Maintenance
Safety Line Checking

 

Show equipment you can operate:
Training
Years of
Experience
Equipment
Training
Years of
Experience
Woodworking Equipment
Wheel & Tire Balancing Machine
Sheet Metal Equipment
Tire Recapping Mold
Frame & Axle Straightening Equipment
Engine Dynamometer
Engine Rebuilding Equipment
Chassis Dynamometer
Diesel Injection Equipment
Magnetic Crack Detector
Electric Welder
Engine Analyzer
Oxyacetylene Welder
Noise Measuring Equipment
Paint Spray Gun
Smoke Measuring Equipment


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:

DRIVER'S LICENSES
(any held in past three years must be shown)
State
License No.
Type
Exp. Date
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

Class of Equipment
Type of Equipment
(Van, Tank, Flat, Etc.)

Dates
Approx. No. of Miles (total)
From
To
Straight Truck
Tractor And Semi-Trailer
Tractor - Two Trailers
Other


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

Dates
Nature of Accident
(Head-On, Rear-End, Upset, Etc.)
Fatalities
Injuries
Last Accident
Next Previous
Next Previous
Next Previous


Traffic convictions and forfeitures for the past 3 years (other than parking violations):

Location
Date
Charge
Penalty

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)

Name and Address
Occupation
Phone


Person to be notified in case of Emergency:

First Name:
Last Name:
Address:
City:
State:
Zip:
Phone:

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.

Applicant's Name:
Date:
Email:

 

 

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