Application Form "*" indicates required fields Step 1 of 5 - Personal Information 20% Compton Services LLC is committed to the principle of equal employment opportunity for all. It is our policy to ensure that all applicants for employment are treated without regard to age, race, religion, color, national origin, sex, age, veteran status, or any other legally protected status according to applicable local, state, and federal law. All decisions regarding employment and all other personnel actions are made or administered in accordance with these principles. The policy of the company is consistent with the requirements of and objectives set forth in the various statutes, regulations, and executive orders relating to equal employment opportunity.Positions Applied For* Today’s Date* DD slash MM slash YYYY How Did You Learn About Us?* Employee Referral* Walk in* Other Personal InformationLast Name* Last First Name* First Middle Name* Middle Physical Address* Physical Address City State Zip Mailing Address* Mailing Address City State Zip Phone Number*Email* How Long Have You Been at This Address?* DD slash MM slash YYYY Do you Have a Valid Drivers License?* Yes No Driver’s License Number* State* Expiration Date* Class* Current Employer* May We Contact Your Current Employer?* Have You Ever Filed an Application with Compton Services LLC Before?* Yes No If Yes, Please Note an Approximate Date* DD slash MM slash YYYY Have You Ever Been Employed with Compton Services LLC Before?* Yes No If Yes, Please Provide Date(s) Of Employment* DD slash MM slash YYYY Proof of Eligibility to Work in the USA will be Required within (3) Business Days of the Start of Employment with the CompanyUpon Employment, Can You Provide Documentation Establishing Your Identity and Eligibility to be Legally Employed in the United States?* Yes No Are You at Least 18 Years of Age?* Yes No Do You Have Dependable Transportation to and From Work?* On What Date Would You be Able to Begin Work?* Do You Have an Active Non-Compete?* Yes No If Yes, Please Provide A Copy*Max. file size: 512 MB.Are You Currently on Lay Off Status and Subject to Return to Another Employer?* Yes No Did You Serve in the U.S. Armed Forces?* Yes No If Yes, What Branch?* Have You Been Convicted of a Felony in the Last 7 Years?* Yes No If Yes, Explain at Interview. (Indicating Yes Will Not Automatically or Necessarily Eliminate You from Consideration of Employment) EducationHigh School* Name and Location of SchoolYears Attended* Diploma/Degree* Undergraduate College Business/ Trade/ Professional* Name and Location of SchoolYears Attended* Diploma/Degree* College* Name and Location of SchoolYears Attended* Diploma/Degree* Additional InformationSummarize Special Job-Related Skills & Qualifications You Feel May be Helpful to us in Considering Your Application Employment HistoryGive a Complete Record of Employment, Including Military, and Reasons for Periods Unemployed. Start With the Most Recent. Applicants Must List ALL Employers Within the Previous Ten Years. If You Have Served in the Armed Forces, Please Attach a Copy of Your DD214.Most Recent Employer* Address* Dates EmployedFrom* DD slash MM slash YYYY To* DD slash MM slash YYYY Telephone Number(s)* Add RemoveClick the plus (+) icon if you want to add more than one telephone number.Job Title* Wage/SalaryBeginning* End* Supervisor Name* Supervisor Phone Number*Work Performed*Reason For Leaving*Most Recent Employer* Address* Dates EmployedFrom* DD slash MM slash YYYY To* DD slash MM slash YYYY Telephone Number(s)* Add RemoveClick the plus (+) icon if you want to add more than one telephone number.Job Title* Wage/SalaryBeginning* End* Supervisor Name* Supervisor Phone Number*Work Performed*Reason For Leaving*Most Recent Employer* Address* Dates EmployedFrom* DD slash MM slash YYYY To* DD slash MM slash YYYY Telephone Number(s) Add RemoveClick the plus (+) icon if you want to add more than one telephone number.Job Title Wage/SalaryBeginning* End* Supervisor Name* Supervisor Phone Number*Work Performed*Reason For Leaving*Most Recent Employer* Address* Dates EmployedFrom* DD slash MM slash YYYY To* DD slash MM slash YYYY Telephone Number(s) Add RemoveClick the plus (+) icon if you want to add more than one telephone number.Job Title* Wage/SalaryBeginning* End* Supervisor Name* Supervisor Phone Number*Work Performed*Reason For Leaving*Most Recent Employer* Address* Dates EmployedFrom* DD slash MM slash YYYY To* DD slash MM slash YYYY Telephone Number(s)* Add RemoveClick the plus (+) icon if you want to add more than one telephone number.Job Title Wage/SalaryBeginning* End* Supervisor Name* Supervisor Phone Number*Work Performed*Reason For Leaving*Please Explain Any Gaps in Employment and/or Unemployment Below. Include Reasons & Dates (Mo/Yr)To Be Read and Signed By Applicant* I authorize you to make investigations and inquiries to my personal, employment, financial, and/or medical history and other related matters as necessary in making an employment decision. I release employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the company.Signature*Printed Name* Date* DD slash MM slash YYYY This certifies that I completed this application and all entries on it and information in it are true and complete to the best of my knowledge.* This certifies that I completed this application and all entries on it and information in it are true and complete to the best of my knowledge.*Signature*Printed Name* Date* DD slash MM slash YYYY This Section Must Be Completed By All ApplicantsThe following requested information is in accordance with the 49 CFR Parts 382.413, 391.413, 391.21, and 391.23 of the Federal Motor Carrier Regulations for the Federal Highway Department. Prior employers may be contacted, for the purpose of investigating applicant’s background as required by 49 CFR 391.23.Name* First Middle Last Social Security Number* DOB* DD slash MM slash YYYY Driver’s License #* State* Expiration Date* DD slash MM slash YYYY Endorsement(s)* Previous Three Years ResidencyStreet* City* State & Zip Code* Years* Street* City* State & Zip Code* Years* Street* City* State & Zip Code* Years* Driving ExperienceStraight Truck (Class Of Equipment)*Type Of EquipmentDate FromDate ToApprox. # Of MilesTractor & Semi-Trailer (Class Of Equipment)*Type Of EquipmentDate FromDate ToApprox. # Of MilesTractor-Two Trailers (Class Of Equipment)*Type Of EquipmentDate FromDate ToApprox. # Of MilesOther (Class Of Equipment)*Type Of EquipmentDate FromDate ToApprox. # Of Miles Add RemoveUse the plus (+) icon if you want to add more driving experience.List of all motor vehicle accidents during the past (3) years*Date of AccidentNature of Violation/AccidentFatalities/InjuriesAt fault Add RemoveUse the plus (+) icon if you have more than one vehicle accidents.Traffic Convictions & Forfeitures For the Past 3 Years (Other than Parking Violations)*Date ConvictedViolationState of ViolationPenalty Add RemoveUse the plus (+) icon if you have more than one traffic convictions & forfeitures.Have you ever been denied a license, permit, or privilege to operate a motor vehicle?* Yes No Has any license you held ever been suspended or revoked?* Yes No If you answered yes to any of the above questions, please provide details.*Have you ever tested positive, or refused to test, on any pre-employment drug test administered by an employer to which you applied for in the past (2) years?* Yes No Employment StatementIn completing and submitting this application, I understand and agree that:* I am applying for a job as an at-will employee. Falsification or concealment of facts, or failure to provide accurate information during the application process, can result in discharge.I hereby certify that this application was completed by me, and that all information is factual to the best of my knowledge. I agree that any party who discloses information pertaining to my application is not held liable for the outcome of my employment.I consent to the pre-employment processes required by Compton Services LLC and understand that my offer of employment is contingent upon the successful completion of these processes, which may include, but are not limited to, the following: Motor Vehicle Report (MVR) Drug Screen Physical Examination and Functional Capacity Alcohol Screening Background Check My signature below represents my acknowledgment and understanding of the above, as well as that this application in no way constitutes an obligation of employment.Signature*Printed Name* Social Security Number* Date* DD slash MM slash YYYY DOB* DD slash MM slash YYYY Driver’s License Number/State*