apply.terpeningtrucking.com
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52.152.140.131
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URL:
https://apply.terpeningtrucking.com/
Submission Tags: @phishunt_io
Submission: On February 25 via api from DE — Scanned from DE
Submission Tags: @phishunt_io
Submission: On February 25 via api from DE — Scanned from DE
Form analysis 1 forms found in the DOM
Name: frmApplication — POST /Application/SendServer
<form action="/Application/SendServer" id="frmApplication" method="post" name="frmApplication" role="application" class="wizard clearfix" novalidate="novalidate">
<div class="steps clearfix">
<ul role="tablist">
<li role="tab" class="first current" aria-disabled="false" aria-selected="true">
<a id="frmApplication-t-0" href="#frmApplication-h-0" aria-controls="frmApplication-p-0"><span class="current-info audible">current step: </span><span class="number">1.</span> Contact Info</a></li>
<li role="tab" class="disabled" aria-disabled="true"><a id="frmApplication-t-1" href="#frmApplication-h-1" aria-controls="frmApplication-p-1"><span class="number">2.</span> Shift Policy</a></li>
<li role="tab" class="disabled" aria-disabled="true"><a id="frmApplication-t-2" href="#frmApplication-h-2" aria-controls="frmApplication-p-2"><span class="number">3.</span> Non-Driver Application</a></li>
<li role="tab" class="disabled" aria-disabled="true"><a id="frmApplication-t-3" href="#frmApplication-h-3" aria-controls="frmApplication-p-3"><span class="number">4.</span> CDL Driver Application</a></li>
<li role="tab" class="disabled last" aria-disabled="true"><a id="frmApplication-t-4" href="#frmApplication-h-4" aria-controls="frmApplication-p-4"><span class="number">5.</span> Applicant Certification</a></li>
</ul>
</div>
<div class="content clearfix"><input name="__RequestVerificationToken" type="hidden" value="CU4ipxFxcn6J9VCdOSBbwgbLjkjkOTeDbChRaEus4EFzzXqDVptOHD3OF8nKWHCJrEYQA0UFvE_VXzKWs4bBXTKegtUhXslIgSFmPzVx5CA1"><input id="ThankYouUrl" name="ThankYouUrl"
type="hidden" value="thank-you"><input data-val="true" data-val-number="The field Int32 must be a number." data-val-required="The Int32 field is required." id="PageDataID" name="PageDataID" type="hidden" value="13626">
<h3 id="frmApplication-h-0" tabindex="-1" class="title current">Contact Info</h3>
<fieldset id="frmApplication-p-0" role="tabpanel" aria-labelledby="frmApplication-h-0" class="body current" aria-hidden="false">
<legend></legend>
<section>
<div class="col-12">
<div class="alert-warning">
<p class="text-center font-italic font-weight-bold">Please Answer All Questions. Resumes Are Not a Substitute for a Completed Application</p>
<p>We are an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, religion, sex, national origin, age, physical or mental disability, genetic
information or any other category protected by applicable federal, state or local laws.</p>
<p>THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON,
WITH OR WITHOUT CAUSE OR NOTICE.</p>
</div>
</div>
<div class="row">
<div class="col-md-6">
<div class="card">
<div class="card-header p-2">
<h5 class="control-label"><b>Position</b></h5>
<h5>Driver applicants will not need to complete Step 3</h5>
<h5>Non-Driver applicants will not need to complete Step 4</h5>
</div>
<div class="card-body">
<div class="row">
<div class="form-group col-md-2">
<label class="control-label">CDL Driver</label><input checked="checked" class="form-control" id="PositionDesired" name="PositionDesired" type="radio" value="True">
</div>
<div class="form-group col-md-2">
<label class="control-label">Non-Driver</label><input htmlattributes="{ class = form-control }" id="PositionDesired" name="PositionDesired" type="radio" value="False">
</div>
<div class="form-group col-md-8">
<label class="control-label required" for="Position">Position Applied For</label>
<input class="form-control text-box single-line" id="Position" name="Position" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="Position" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="form-group col-md-3">
<label class="control-label required" for="FullName">Name</label>
<input class="form-control text-box single-line" id="FullName" name="FullName" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="FullName" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-3">
<label class="control-label required" for="Email">Email</label>
<input class="form-control text-box single-line" data-val="true" data-val-regex="Invalid email format" data-val-regex-pattern="(.*)@(.*).(com|edu|gov|int|mil|net|org|biz|info|name|pro|museum|co.uk|in|ca|cc)" id="Email" name="Email"
type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="Email" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-3">
<label class="control-label required" for="Phone">Telephone Number</label>
<input class="form-control text-box single-line" id="Phone" name="Phone" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="Phone" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-3">
<label class="control-label" for="AlternatePhone">Alternate or Cell Telephone Number</label>
<input class="form-control text-box single-line" id="AlternatePhone" name="AlternatePhone" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="AlternatePhone" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-12">
<label class="control-label required" for="Address">Present Address</label>
<input class="form-control text-box single-line" id="Address" name="Address" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="Address" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-3">
<label class="control-label required" for="City">City</label>
<input class="form-control text-box single-line" id="City" name="City" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="City" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-3">
<label class="control-label required" for="State">State</label>
<input class="form-control text-box single-line" id="State" name="State" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="State" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-3">
<label class="control-label required" for="Zip">Zip</label>
<input class="form-control text-box single-line" id="Zip" name="Zip" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="Zip" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-3">
<label class="control-label required" for="YearsAddress">How long have you lived there?</label>
<input class="form-control text-box single-line" id="YearsAddress" name="YearsAddress" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="YearsAddress" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-12">
<label class="control-label" for="PreviousAddress">Previous Address</label>
<input class="form-control text-box single-line" id="PreviousAddress" name="PreviousAddress" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PreviousAddress" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-3">
<label class="control-label" for="PreviousCity">City</label>
<input class="form-control text-box single-line" id="PreviousCity" name="PreviousCity" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PreviousCity" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-3">
<label class="control-label" for="PreviousState">State</label>
<input class="form-control text-box single-line" id="PreviousState" name="PreviousState" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PreviousState" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-3">
<label class="control-label" for="PreviousZip">Zip</label>
<input class="form-control text-box single-line" id="PreviousZip" name="PreviousZip" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PreviousZip" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-3">
<label class="control-label" for="PreviousYearsAddress">How long have you lived there?</label>
<input class="form-control text-box single-line" id="PreviousYearsAddress" name="PreviousYearsAddress" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PreviousYearsAddress" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label required" for="StartWorkDate">Date on which you can start work if hired</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field Date on which you can start work if hired must be a date." id="StartWorkDate" name="StartWorkDate" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="StartWorkDate" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label required" for="Salary">Desired Salary/Hourly Rate</label>
<input class="form-control text-box single-line" id="Salary" name="Salary" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="Salary" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row mb-3">
<div class="col-md-6">
<div class="card">
<div class="card-header p-2">
<h5 class="control-label"><b>Type of employment desired?</b></h5>
</div>
<div class="card-body">
<div class="row">
<div class="form-group col-md-2">
<label class="control-label">Full-Time</label> <input checked="checked" class="form-control" data-val="true" data-val-required="The FullPartTime field is required." id="FullPartTime" name="FullPartTime" type="radio" value="False">
</div>
<div class="form-group col-md-2">
<label class="control-label">Part-Time</label><input htmlattributes="{ class = form-control }" id="FullPartTime" name="FullPartTime" type="radio" value="True">
</div>
<div class="form-group col-md-8">
<label class="control-label" for="Hours">(Specify Hours)</label>
<input class="form-control text-box single-line" id="Hours" name="Hours" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="Hours" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
</div>
<div class="col-md-6">
<div class="row pl-3 pr-3">
<label class="control-label align-middle customerror" for="Overtime">Are you willing to work overtime?</label>
<label class="radio-inline">Yes </label> <input class="form-control" id="Overtime" name="Overtime" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="Overtime" name="Overtime" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="Overtime" data-valmsg-replace="true"></span>
</div>
<div class="row pl-3 pr-3">
<label class="control-label align-middle" for="WorkCertificate">If under the age of 18, Can you produce the necessary work certificate at time of employment?</label>
<label class="radio-inline">Yes </label> <input class="form-control" id="WorkCertificate" name="WorkCertificate" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="WorkCertificate" name="WorkCertificate" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="WorkCertificate" data-valmsg-replace="true"></span>
</div>
</div>
</div>
<div class="row pl-3 pr-3">
<label class="control-label customerrorPreviouslyApplied" for="PreviouslyApplied">Have you previously applied for employment with this Company?</label>
<label class="radio-inline">Yes </label> <input class="form-control" id="PreviouslyApplied" name="PreviouslyApplied" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="PreviouslyApplied" name="PreviouslyApplied" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="PreviouslyApplied" data-valmsg-replace="true"></span>
</div>
<div class="row mb-3">
<div class="col-md-12">
<label class="control-label" for="PreviouslyAppliedDetails">If yes, when and where did you apply?</label>
<textarea class="form-control text-box multi-line" data-val="true" data-val-length="Details must be 1000 characters or less" data-val-length-max="1000" id="PreviouslyAppliedDetails" name="PreviouslyAppliedDetails"></textarea>
<span class="field-validation-valid text-danger" data-valmsg-for="PreviouslyAppliedDetails" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row pl-3 pr-3">
<label class="control-label customerrorEmployedBefore" for="EmployedBefore">Have you ever been employed by this Company?</label>
<label class="radio-inline">Yes </label><input class="form-control" id="EmployedBefore" name="EmployedBefore" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="EmployedBefore" name="EmployedBefore" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="EmployedBefore" data-valmsg-replace="true"></span>
</div>
<div class="row">
<div class="col-md-12">
<label class="control-label" for="EmploymentDetails">If Yes, provide dates of employment, location, and reason for separation from employment.</label>
<textarea class="form-control text-box multi-line" data-val="true" data-val-length="Details must be 1000 characters or less" data-val-length-max="1000" id="EmploymentDetails" name="EmploymentDetails"></textarea>
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentDetails" data-valmsg-replace="true"></span>
</div>
</div>
<div class="col-12 mt-2">
<div class="alert-warning">
<u>INSTRUCTIONS FOR ANSWERING THE NEXT TWO QUESTIONS</u>
<p> 1. All applicants: Do not include convictions that were sealed; eradicated, erased; annulled by a court, or expunged, or convictions that resulted in referral to a diversion program.<br> 2. Arizona, Colorado, District of Columbia,
Illinois, Kansas, Minnesota, Missouri, Montana, Nevada, Rhode Island, South Carolina and Utah applicants: Do not respond to the second question regarding arrests.<br> 3. California applicants: Do not include misdemeanor
marijuana-related convictions that are more than two (2) years old or misdemeanor convictions for which probation was successfully completed or otherwise discharged and the case was judicially dismissed.<br> 4. Connecticut applicants:
You are not required to disclose the existence of any arrest, criminal charge, or conviction, the records of which have been erased. Criminal records subject to erasure are records pertaining to a finding of delinquency or the fact that
a chl1d was a member of a family with service needs, an adjudication as a youthful offender, a criminal charge that has been dismissed or knolled (not prosecuted), a criminal charge for which the person was found not guilty, or a
conviction for which the offender received An absolute pardon. Any person whose criminal records have been erased is deemed to have never been arrested within the meaning of The law as it applies to the particular proceedings that have
been erased, and may so swear under oath.<br> 5. District of Columbia and Washington applicants: Limit any response to the past ten (10) years.<br> 6. Hawaii and Massachusetts applicants; Do not answer the following two questions.<br>
7. Indiana applicants: Regarding arrests limit your response to pending charges for felonies and class A misdemeanors that are less than One (1)<br> 8. Michigan applicants: Regarding arrests, limit your response to felony arrests
awaiting conviction or dismissal.<br> 9. New York applicants: All pending arrests or criminal accusations must be disclosed. You are not required to disclose arrests or criminal accusations at resulted in criminal actions or proceeding
which were terminated in your favor. Do not disclose criminal actions or proceedings that were sealed or classified as youthful offender adjudications. An ex-offender who is denied employment may, upon written request, receive a
statement of the reason(s) for denial within thirty (30) days of the applicant's request for such information.<br> 10. North Dakota and Oregon applicants: Regarding arrests, limit your response to pending charges that are less than one
(1) year old.<br> 11. Utah applicants; Limit any response to felony convictions only. Do not respond to the second question regarding arrests.<br>
</p>
</div>
</div>
<div class="row pl-3 pr-3">
<label class="control-label customerrorCriminalOffense" for="CriminalOffense">Have you ever plead guilty or no contest to, or been convicted of any criminal offense other than the applicable exceptions listed above?</label>
<label class="radio-inline">Yes </label> <input class="form-control" id="CriminalOffense" name="CriminalOffense" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="CriminalOffense" name="CriminalOffense" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="CriminalOffense" data-valmsg-replace="true"></span>
</div>
<div class="row pl-3 pr-3">
<label class="control-label customerrorArrested" for="Arrested">Have you ever been arrested for any matters for which you currently are out on bail or on your own recognizance pending?</label>
<label class="radio-inline">Yes </label> <input class="form-control" id="Arrested" name="Arrested" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="Arrested" name="Arrested" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="Arrested" data-valmsg-replace="true"></span>
</div>
<div class="row">
<div class="col-md-12">
<label class="control-label" for="CriminalArrestDetails">Criminal OFFENSES ONLY: If you answered Yes, to either of the above two questions, please provide the date(s) and explain in accordance with the above instructions so that
individual circumstances can be considered.</label>
<textarea class="form-control text-box multi-line" data-val="true" data-val-length="Details must be 1000 characters or less" data-val-length-max="1000" id="CriminalArrestDetails" name="CriminalArrestDetails"></textarea>
<span class="field-validation-valid text-danger" data-valmsg-for="CriminalArrestDetails" data-valmsg-replace="true"></span>
</div>
</div>
<div class="col-12 mt-3">
<div class="alert-warning">
<i>Criminal convictions or arrests will not automatically disqualify an applicant from a particular job. The Company will consider the nature of the crime, its seriousness, the substantial relation to the position's functions and qualifications, the number of occurrences, the applicant's age at the time of the crime, the time elapsed since the crime, the applicant's entire work and educational history, employment references and recommendations, and the business necessity of any exclusion when required by law.</i>
</div>
</div>
<div class="row pl-3 pr-3">
<label class="control-label customerrorWorkPlaceViolence" for="WorkPlaceViolence">Have you ever initiated an act of violence in the workplace?</label>
<label class="radio-inline">Yes </label> <input class="form-control" id="WorkPlaceViolence" name="WorkPlaceViolence" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="WorkPlaceViolence" name="WorkPlaceViolence" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="WorkPlaceViolence" data-valmsg-replace="true"></span>
</div>
<div class="row">
<div class="col-md-12">
<label class="control-label" for="WorkplaceViolenceDetails">If yes, please provide the date(s) and explain so that individual circumstances can be considered. (A 'Yes' answer will not necessarily disqualify you from employment)</label>
<textarea class="form-control text-box multi-line" data-val="true" data-val-length="Details must be 1000 characters or less" data-val-length-max="1000" id="WorkplaceViolenceDetails" name="WorkplaceViolenceDetails"></textarea>
<span class="field-validation-valid text-danger" data-valmsg-for="WorkplaceViolenceDetails" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="col-md-12">
<label class="control-label" for="TechnicalSkills">List all special technical skills that you feel qualify you for the job for which you are applying (For example, computer programming/language, software, equipment operation, special
tools or machines, etc.)</label>
<textarea class="form-control text-box multi-line" data-val="true" data-val-length="Technical Skills must be 1000 characters or less" data-val-length-max="1000" id="TechnicalSkills" name="TechnicalSkills"></textarea>
<span class="field-validation-valid text-danger" data-valmsg-for="TechnicalSkills" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row mt-2 mb-2">
<div class="col-md-4">
<div class="card">
<div class="card-header p-2">
<h5 class="font-weight-bold">High School</h5>
</div>
<div class="card-body">
<div class="row">
<label class="control-label required" for="HighSchoolName">School Name and Location</label>
<textarea class="form-control text-box multi-line" data-val="true" data-val-length="High school name and location must be 250 characters or less" data-val-length-max="250" id="HighSchoolName" name="HighSchoolName"></textarea>
<span class="field-validation-valid text-danger" data-valmsg-for="HighSchoolName" data-valmsg-replace="true"></span>
</div>
<div class="row mt-3">
<label class="control-label required" for="HighSchoolCourses">Course of Study</label>
<input class="form-control text-box single-line" data-val="true" data-val-length="High school course of study must be 250 characters or less" data-val-length-max="250" id="HighSchoolCourses" name="HighSchoolCourses" type="text"
value="">
<span class="field-validation-valid text-danger" data-valmsg-for="HighSchoolCourses" data-valmsg-replace="true"></span>
</div>
<div class="row mt-3">
<label class="control-label customerrorHighSchoolGraduate" for="HighSchoolGraduate">Did You Graduate?</label>
</div>
<div class="row">
<label class="radio-inline pl-0">Yes </label> <input class="form-control" id="HighSchoolGraduate" name="HighSchoolGraduate" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="HighSchoolGraduate" name="HighSchoolGraduate" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="HighSchoolGraduate" data-valmsg-replace="true"></span>
</div>
<div class="row mt-3">
<label class="control-label required" for="HighSchoolYearsCompleted">Years Completed</label>
<input class="form-control text-box single-line" data-val="true" data-val-length="High school number of years completed must be 2 characters or less" data-val-length-max="2" id="HighSchoolYearsCompleted"
name="HighSchoolYearsCompleted" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="HighSchoolYearsCompleted" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
<div class="col-md-4">
<div class="card">
<div class="card-header p-2">
<h5 class="font-weight-bold">College</h5>
</div>
<div class="card-body">
<div class="row">
<label class="control-label" for="CollegeName">School Name and Location</label>
<textarea class="form-control text-box multi-line" id="CollegeName" name="CollegeName"></textarea>
<span class="field-validation-valid text-danger" data-valmsg-for="CollegeName" data-valmsg-replace="true"></span>
</div>
<div class="row mt-3">
<label class="control-label" for="CollegeCourses">Course of Study</label>
<input class="form-control text-box single-line" id="CollegeCourses" name="CollegeCourses" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="CollegeCourses" data-valmsg-replace="true"></span>
</div>
<div class="row mt-3">
<label class="control-label" for="CollegeGraduate">Did You Graduate?</label><br>
</div>
<div class="row">
<label class="radio-inline pl-0">Yes </label> <input class="form-control" id="CollegeGraduate" name="CollegeGraduate" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="CollegeGraduate" name="CollegeGraduate" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="CollegeGraduate" data-valmsg-replace="true"></span>
</div>
<div class="row mt-3">
<div class="col-md-6">
<label class="control-label" for="CollegeYearsCompleted">Years Completed</label>
<input class="form-control text-box single-line" id="CollegeYearsCompleted" name="CollegeYearsCompleted" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="CollegeYearsCompleted" data-valmsg-replace="true"></span>
</div>
<div class="col-md-6">
<label class="control-label" for="CollegeDegree">Degree/Major</label>
<input class="form-control text-box single-line" id="CollegeDegree" name="CollegeDegree" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="CollegeDegree" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
</div>
<div class="col-md-4">
<div class="card">
<div class="card-header p-2">
<h5 class="font-weight-bold">Bus/Tech/Trade or Post College</h5>
</div>
<div class="card-body">
<div class="row">
<label class="control-label" for="BusinessName">School Name and Location</label>
<textarea class="form-control text-box multi-line" data-val="true" data-val-length="Bus/Tech/Trade name and location must be 250 characters or less" data-val-length-max="250" id="BusinessName" name="BusinessName"></textarea>
<span class="field-validation-valid text-danger" data-valmsg-for="BusinessName" data-valmsg-replace="true"></span>
</div>
<div class="row mt-3">
<label class="control-label" for="BusinessCourses">Course of Study</label>
<input class="form-control text-box single-line" data-val="true" data-val-length="Bus/Tech/Trade course of study must be 250 characters or less" data-val-length-max="250" id="BusinessCourses" name="BusinessCourses" type="text"
value="">
<span class="field-validation-valid text-danger" data-valmsg-for="BusinessCourses" data-valmsg-replace="true"></span>
</div>
<div class="row mt-3">
<label class="control-label" for="BusinessGraduate">Did You Graduate?</label><br>
</div>
<div class="row">
<label class="radio-inline pl-0">Yes </label> <input class="form-control" id="BusinessGraduate" name="BusinessGraduate" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="BusinessGraduate" name="BusinessGraduate" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="BusinessGraduate" data-valmsg-replace="true"></span>
</div>
<div class="row mt-3">
<div class="col-md-6">
<label class="control-label" for="BusinessYearsCompleted">Years Completed</label>
<input class="form-control text-box single-line" data-val="true" data-val-length="Bus/Tech/Trade number of years completed must be 2 characters or less" data-val-length-max="2" id="BusinessYearsCompleted"
name="BusinessYearsCompleted" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="BusinessYearsCompleted" data-valmsg-replace="true"></span>
</div>
<div class="col-md-6">
<label class="control-label" for="BusinessDegree">Degree/Major</label>
<input class="form-control text-box single-line" data-val="true" data-val-length="Degree/Major must be 50 characters or less" data-val-length-max="50" id="BusinessDegree" name="BusinessDegree" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="BusinessDegree" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="form-group col-md-12">
<label class="control-label" for="HonorsReceived">Honors Received</label>
<textarea class="form-control text-box multi-line" id="HonorsReceived" name="HonorsReceived"></textarea>
<span class="field-validation-valid text-danger" data-valmsg-for="HonorsReceived" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-12">
<label class="control-label" for="Aliases">If applicable, list below any other names by which you have been known which may be necessary to allow us to confirm your work and educational record.For example, change of name, use of an
assumed name, nickname, etc.</label>
<textarea class="form-control text-box multi-line" id="Aliases" name="Aliases"></textarea>
<span class="field-validation-valid text-danger" data-valmsg-for="Aliases" data-valmsg-replace="true"></span>
</div>
</div>
<div class="col-12">
<div class="alert-warning">
<p><b><u>REFERENCES</u></b></p>
<p>Please list the names of additional work-related references we may contact. Individuals with no prior work experience may list school or volunteer-related references. </p>
</div>
</div>
<div class="card-deck">
<div class="card">
<div class="card-header">
<h5 class="font-weight-bold m-2">Reference 1</h5>
</div>
<div class="card-body">
<div class="row">
<div class="form-group col-md-6">
<label class="control-label required" for="RefName1">Name</label>
<input class="form-control text-box single-line" id="RefName1" name="RefName1" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="RefName1" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label required" for="RefPosition1">Position</label>
<input class="form-control text-box single-line" id="RefPosition1" name="RefPosition1" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="RefPosition1" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label required" for="refCompany1">Company</label>
<input class="form-control text-box single-line" id="refCompany1" name="refCompany1" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="refCompany1" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label required" for="RefPhone1">Telephone</label>
<input class="form-control text-box single-line" data-val="true" data-val-length="Telephone must be 50 characters or less" data-val-length-max="50" id="RefPhone1" name="RefPhone1" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="RefPhone1" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-12">
<label class="control-label required" for="refRelationship1">Work Relationship (i.e Supervisor, Co-worker)</label>
<input class="form-control text-box single-line" id="refRelationship1" name="refRelationship1" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="refRelationship1" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
<div class="card">
<div class="card-header">
<h5 class="font-weight-bold m-2">Reference 2</h5>
</div>
<div class="card-body">
<div class="row">
<div class="form-group col-md-6">
<label class="control-label required" for="RefName2">Name</label>
<input class="form-control text-box single-line" id="RefName2" name="RefName2" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="RefName2" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label required" for="RefPosition2">Position</label>
<input class="form-control text-box single-line" id="RefPosition2" name="RefPosition2" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="RefPosition2" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label required" for="refCompany2">Company</label>
<input class="form-control text-box single-line" id="refCompany2" name="refCompany2" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="refCompany2" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label required" for="RefPhone2">Telephone</label>
<input class="form-control text-box single-line" id="RefPhone2" name="RefPhone2" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="RefPhone2" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-12">
<label class="control-label required" for="refRelationship2">Work Relationship (i.e Supervisor, Co-worker)</label>
<input class="form-control text-box single-line" id="refRelationship2" name="refRelationship2" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="refRelationship2" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
</div>
<div class="col-12 mt-3">
<div class="alert-warning">
<p>Please list the names of personal references (not previous employers or relatives) who know you well that we may contact. </p>
</div>
</div>
<div class="card-deck">
<div class="card">
<div class="card-header">
<h5 class="font-weight-bold m-2">Personal Reference 1</h5>
</div>
<div class="card-body">
<div class="row">
<div class="form-group col-md-6">
<label class="control-label required" for="PersonalRefName1">Name</label>
<input class="form-control text-box single-line" id="PersonalRefName1" name="PersonalRefName1" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PersonalRefName1" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label required" for="PersonalRefOccupation1">Occupation</label>
<input class="form-control text-box single-line" id="PersonalRefOccupation1" name="PersonalRefOccupation1" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PersonalRefOccupation1" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label required" for="PersonalRefPhone1">Telephone</label>
<input class="form-control text-box single-line" id="PersonalRefPhone1" name="PersonalRefPhone1" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PersonalRefPhone1" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label required" for="PersonalRefYears1">Number of Years Known</label>
<input class="form-control text-box single-line" data-val="true" data-val-number="The field Number of Years Known must be a number." id="PersonalRefYears1" name="PersonalRefYears1" type="number" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PersonalRefYears1" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-12">
<label class="control-label required" for="PersonalRefAddress1">Address</label>
<input class="form-control text-box single-line" id="PersonalRefAddress1" name="PersonalRefAddress1" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PersonalRefAddress1" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
<div class="card">
<div class="card-header">
<h5 class="font-weight-bold m-2">Personal Reference 2</h5>
</div>
<div class="card-body">
<div class="row">
<div class="form-group col-md-6">
<label class="control-label required" for="PersonalRefName2">Name</label>
<input class="form-control text-box single-line" id="PersonalRefName2" name="PersonalRefName2" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PersonalRefName2" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label required" for="PersonalRefOccupation2">Occupation</label>
<input class="form-control text-box single-line" id="PersonalRefOccupation2" name="PersonalRefOccupation2" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PersonalRefOccupation2" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label required" for="PersonalRefPhone2">Telephone</label>
<input class="form-control text-box single-line" id="PersonalRefPhone2" name="PersonalRefPhone2" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PersonalRefPhone2" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label required" for="PersonalRefYears2">Number of Years Known</label>
<input class="form-control text-box single-line" data-val="true" data-val-number="The field Number of Years Known must be a number." id="PersonalRefYears2" name="PersonalRefYears2" type="number" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PersonalRefYears2" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-12">
<label class="control-label required" for="PersonalRefAddress2">Address</label>
<input class="form-control text-box single-line" id="PersonalRefAddress2" name="PersonalRefAddress2" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PersonalRefAddress2" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
</div>
</section>
</fieldset>
<h3 id="frmApplication-h-1" tabindex="-1" class="title">Shift Policy</h3>
<fieldset id="frmApplication-p-1" role="tabpanel" aria-labelledby="frmApplication-h-1" class="body" aria-hidden="true" style="display: none;">
<legend></legend>
<section>
<div class="col-12">
<div class="alert-warning">
<p><b><u>AGREEMENT TO ACCEPT NIGHT AND WEEKEND WORK</u></b></p>
<p>Applicant: <br> A second shift is required to meet our present needs. All new employees are hired with the understanding that they are able and willing to work nights and weekends.<br> Please answer the following: </p>
</div>
</div>
<div class="row pl-3 pr-3">
<label class="control-label customerrorPhysicalCondition" for="PhysicalCondition">1) Do you have any physical condition that would prevent You from working nights? </label>
<label class="radio-inline">Yes </label> <input class="form-control" id="PhysicalCondition" name="PhysicalCondition" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="PhysicalCondition" name="PhysicalCondition" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="PhysicalCondition" data-valmsg-replace="true"></span>
</div>
<div class="row pl-3 pr-3">
<label class="control-label customerrorPersonalReasons" for="PersonalReasons">2) Do you know of any personal reasons that would Interfere with your working nights and weekends ? </label>
<label class="radio-inline">Yes </label> <input class="form-control" id="PersonalReasons" name="PersonalReasons" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="PersonalReasons" name="PersonalReasons" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="PersonalReasons" data-valmsg-replace="true"></span>
</div>
<div class="row pl-3 pr-3">
<label class="control-label customerrorWillingToWorkWeekends" for="WillingToWorkWeekends">3) Are you willing to work nights and weekends?</label>
<label class="radio-inline">Yes </label> <input class="form-control" id="WillingToWorkWeekends" name="WillingToWorkWeekends" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="WillingToWorkWeekends" name="WillingToWorkWeekends" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="WillingToWorkWeekends" data-valmsg-replace="true"></span>
</div>
<div class="col-12">
<div class="alert-warning">
<p>I understand that any employment is conditioned upon my acceptance of a night and weekend assignment.</p>
</div>
</div>
<div class="row">
<div class="form-group col-md-4">
<label class="control-label required" for="Signed">Signed</label>
<input class="form-control text-box single-line" id="Signed" name="Signed" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="Signed" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-4">
<label class="control-label required" for="Dated">Dated</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field Dated must be a date." id="Dated" name="Dated" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="Dated" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-4">
<label class="control-label required" for="InThePresenceOf">In the presence of</label>
<input class="form-control text-box single-line" id="InThePresenceOf" name="InThePresenceOf" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="InThePresenceOf" data-valmsg-replace="true"></span>
</div>
</div>
</section>
</fieldset>
<h3 id="frmApplication-h-2" tabindex="-1" class="title">Non-Driver Application</h3>
<fieldset id="frmApplication-p-2" role="tabpanel" aria-labelledby="frmApplication-h-2" class="body" aria-hidden="true" style="display: none;">
<legend></legend>
<section>
<div class="row">
<div class="form-group col-md-12">
<div class="alert-warning">
<p class="text-center">THIS PAGE TO BE FILLED OUT BY <b><u>NON-DRIVER</u></b> APPLICANTS <b><u>ONLY</u></b></p>
<p>Please list the names of your present and/or previous employers in chronological order with present or last employer list first. Account for all periods of time including any period of unemployment. If self-employed, supply firm name
and business references. You may include any verifiable work performed on a volunteer basis, internships, or military service. Your failure to completely respond to each inquiry my disqualify you for consideration from employment.</p>
</div>
</div>
</div>
<div id="divHistoryNonDrivers">
<div class="historyNonDriversList">
<div id="employmentnondriver_1" class="card mb-3">
<div class="card-header p-2">
<div class="pull-left h4 p-2 m-0">#1</div>
</div>
<div class="card-body">
<div class="row">
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="EmployerNonDriver">Employer</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryNonDrivers_0__EmployerNonDriver" name="EmploymentHistoryNonDrivers[0].EmployerNonDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryNonDrivers[0].EmployerNonDriver" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="AddressNonDriver">Address</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryNonDrivers_0__AddressNonDriver" name="EmploymentHistoryNonDrivers[0].AddressNonDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryNonDrivers[0].AddressNonDriver" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="PhoneNonDriver">Telephone</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryNonDrivers_0__PhoneNonDriver" name="EmploymentHistoryNonDrivers[0].PhoneNonDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryNonDrivers[0].PhoneNonDriver" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="TypeOfBusinessNonDriver">Type of Business</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryNonDrivers_0__TypeOfBusinessNonDriver" name="EmploymentHistoryNonDrivers[0].TypeOfBusinessNonDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryNonDrivers[0].TypeOfBusinessNonDriver" data-valmsg-replace="true"></span>
</div>
</div>
</div>
<div class="row">
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="JobTitleNonDriver">Job Title</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryNonDrivers_0__JobTitleNonDriver" name="EmploymentHistoryNonDrivers[0].JobTitleNonDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryNonDrivers[0].JobTitleNonDriver" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="EmploymentStartDateNonDriver">Date Employed From</label>
<div class="col-md-12">
<input class="form-control date-control flatpickr-input" id="EmploymentHistoryNonDrivers_0__EmploymentStartDateNonDriver" name="EmploymentHistoryNonDrivers[0].EmploymentStartDateNonDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryNonDrivers[0].EmploymentStartDateNonDriver" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="EmploymentEndDateNonDriver">Date Employed To</label>
<div class="col-md-12">
<input class="form-control date-control flatpickr-input" id="EmploymentHistoryNonDrivers_0__EmploymentEndDateNonDriver" name="EmploymentHistoryNonDrivers[0].EmploymentEndDateNonDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryNonDrivers[0].EmploymentEndDateNonDriver" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="DutiesNonDriver">Duties</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryNonDrivers_0__DutiesNonDriver" name="EmploymentHistoryNonDrivers[0].DutiesNonDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryNonDrivers[0].DutiesNonDriver" data-valmsg-replace="true"></span>
</div>
</div>
</div>
<div class="row">
<div class="form-group col-lg-4">
<label class="control-label col-md-12" for="SupervisorsNameNonDriver">Supervisor's Name</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryNonDrivers_0__SupervisorsNameNonDriver" name="EmploymentHistoryNonDrivers[0].SupervisorsNameNonDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryNonDrivers[0].SupervisorsNameNonDriver" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<label class="control-label col-md-12" for="ContactAllowed">May we contact?</label>
<label class="radio-inline">Yes </label><input class="form-control" id="EmploymentHistoryNonDrivers_0__ContactAllowed" name="EmploymentHistoryNonDrivers[0].ContactAllowed" type="radio" value="True">
<label class="radio-inline">No </label><input class="form-control" id="EmploymentHistoryNonDrivers_0__ContactAllowed" name="EmploymentHistoryNonDrivers[0].ContactAllowed" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryNonDrivers[0].ContactAllowed" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-lg-4">
<label class="control-label col-md-12" for="NoContactReason">If No, Why not?</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryNonDrivers_0__NoContactReason" name="EmploymentHistoryNonDrivers[0].NoContactReason" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryNonDrivers[0].NoContactReason" data-valmsg-replace="true"></span>
</div>
</div>
</div>
<div class="row">
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="StartWagesNonDriver">Wages Start</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryNonDrivers_0__StartWagesNonDriver" name="EmploymentHistoryNonDrivers[0].StartWagesNonDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryNonDrivers[0].StartWagesNonDriver" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="EndWagesNonDriver">Wages Final</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryNonDrivers_0__EndWages" name="EmploymentHistoryNonDrivers[0].EndWages" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryNonDrivers[0].EndWagesNonDriver" data-valmsg-replace="true"></span>
</div>
</div>
</div>
<div class="row">
<div class="form-group col-lg-12">
<label class="control-label col-md-12" for="TerminationReasonNonDriver">What will this employer say was the reason for your employment terminated?</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryNonDrivers_0__TerminationReasonNonDriver" name="EmploymentHistoryNonDrivers[0].TerminationReasonNonDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryNonDrivers[0].TerminationReasonNonDriver" data-valmsg-replace="true"></span>
</div>
</div>
</div>
<div class="row">
<div class="form-group col-lg-12">
<label class="control-label col-md-12" for="TerminationNoticeNonDriver">How much notice did you give when resigning? If none, explain</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryNonDriversr_0__TerminationNoticeNonDriver" name="EmploymentHistoryNonDriversr[0].TerminationNoticeNonDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryNonDrivers[0].TerminationNoticeNonDriver" data-valmsg-replace="true"></span>
</div>
</div>
</div>
<div class="row">
<div class="form-group col-lg-12">
<label class="control-label col-md-12" for="ReasonForLeavingNonDriver">Reason for Leaving</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryNonDrivers_0__ReasonForLeavingNonDriver" name="EmploymentHistoryNonDrivers[0].ReasonForLeavingNonDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryNonDrivers[0].ReasonForLeavingNonDriver" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
</div>
<script>
$(function() {
// For todays date;
Date.prototype.today = function() {
return (((this.getMonth() + 1) < 10) ? "0" : "") + (this.getMonth() + 1) + "/" + ((this.getDate() < 10) ? "0" : "") + this.getDate() + "/" + this.getFullYear();
}
var newDate = new Date();
flatpickr("#employmentnondriver_1 .date-control", {
//"plugins": [new rangePlugin({ input: "#End" })],
enableTime: false,
dateFormat: "m-d-Y", // h:i"
allowInput: true
});
});
</script>
</div>
<div class="row">
<div class="form-group col-lg-12">
<div class="col-md-12">
<input type="button" id="btnAddEmployerNonDriver" class="btn btn-primary" value="Add Another Employer" data-row-count="1">
</div>
</div>
</div>
</div>
<div class="row">
<div class="form-group col-md-12">
<label class="control-label" for="NonDriverEmploymentGaps">Please explain fully all gaps in your employment history in excess of one month.</label>
<textarea class="form-control text-box multi-line" id="NonDriverEmploymentGaps" name="NonDriverEmploymentGaps"></textarea>
<span class="field-validation-valid text-danger" data-valmsg-for="NonDriverEmploymentGaps" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row pl-3 pr-3">
<label class="control-label" for="NonDriverTerminated">Have you ever been terminated or asked to resign from any job?</label>
<label class="radio-inline">Yes </label> <input class="form-control" id="NonDriverTerminated" name="NonDriverTerminated" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="NonDriverTerminated" name="NonDriverTerminated" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="NonDriverTerminated" data-valmsg-replace="true"></span>
</div>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label" for="TerminatedNumber">If yes, how many times?</label>
<input class="form-control text-box single-line" data-val="true" data-val-number="The field If yes, how many times? must be a number." id="TerminatedNumber" name="TerminatedNumber" type="number" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="TerminatedNumber" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row pl-3 pr-3">
<label class="control-label" for="TerminatedMutualAgreement">Has your employment ever been terminated by mutual agreement?</label>
<label class="radio-inline">Yes </label> <input class="form-control" id="TerminatedMutualAgreement" name="TerminatedMutualAgreement" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="TerminatedMutualAgreement" name="TerminatedMutualAgreement" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="TerminatedMutualAgreement" data-valmsg-replace="true"></span>
</div>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label" for="TerminatedMutualNumber">If yes, how many times?</label>
<input class="form-control text-box single-line" data-val="true" data-val-number="The field If yes, how many times? must be a number." id="TerminatedMutualNumber" name="TerminatedMutualNumber" type="number" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="TerminatedMutualNumber" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row pl-3 pr-3">
<label class="control-label" for="Resign">Have you ever been given the choice to resign rather than be terminated?</label>
<label class="radio-inline">Yes </label> <input class="form-control" id="Resign" name="Resign" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="Resign" name="Resign" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="Resign" data-valmsg-replace="true"></span>
</div>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label" for="ResignNumber">If yes, how many times?</label>
<input class="form-control text-box single-line" data-val="true" data-val-number="The field If yes, how many times? must be a number." id="ResignNumber" name="ResignNumber" type="number" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="ResignNumber" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-12">
<label class="control-label" for="TerminationReasons">If you answered YES to any of the above questions, please explain the circumstances of EACH occasion.</label>
<textarea class="form-control text-box multi-line" id="TerminationReasons" name="TerminationReasons"></textarea>
<span class="field-validation-valid text-danger" data-valmsg-for="TerminationReasons" data-valmsg-replace="true"></span>
</div>
</div>
</section>
</fieldset>
<h3 id="frmApplication-h-3" tabindex="-1" class="title">CDL Driver Application</h3>
<fieldset id="frmApplication-p-3" role="tabpanel" aria-labelledby="frmApplication-h-3" class="body" aria-hidden="true" style="display: none;">
<legend></legend>
<section>
<div class="col-12">
<div class="alert-warning">
<p class="text-center">APPLICATION FOR EMPLOYMENT- CDL DRIVERS ONLY</p>
<p> We are an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed member service, race, religion, sex, national origin, age, genetic information, or any other category protected
by applicable federal, state or local laws. Terpening Trucking Co., Inc. is at at-will employer as allowed by applicable state law. This means regardless of any provision in this application, if hired, the Company or the employee may
terminate the employment relationship at any time, for any reason, without cause or notice. As Terpening Trucking is a DOT-Regulated Carrier, all applicants must be qualified under all applicable DOT regulations. </p>
</div>
</div>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label required" for="NameCdlDriver">Name</label>
<input class="form-control text-box single-line" id="NameCdlDriver" name="NameCdlDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="NameCdlDriver" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label required" for="DOB">DOB</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field DOB must be a date." id="DOB" name="DOB" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="DOB" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row pl-3 pr-3">
<label class="control-label" for="PreviouslyAppliedCdlDriver">Have you previously applied to Terpening Trucking?</label>
<label class="radio-inline">Yes </label> <input class="form-control" id="PreviouslyAppliedCdlDriver" name="PreviouslyAppliedCdlDriver" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="PreviouslyAppliedCdlDriver" name="PreviouslyAppliedCdlDriver" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="PreviouslyAppliedCdlDriver" data-valmsg-replace="true"></span>
</div>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label" for="AppliedDate">If yes, when?</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field If yes, when? must be a date." id="AppliedDate" name="AppliedDate" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="AppliedDate" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row pl-3 pr-3">
<label class="control-label" for="WorkedForTerpening">Have you previously worked for Terpening Trucking?</label>
<label class="radio-inline">Yes </label> <input class="form-control" id="WorkedForTerpening" name="WorkedForTerpening" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="WorkedForTerpening" name="WorkedForTerpening" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="WorkedForTerpening" data-valmsg-replace="true"></span>
</div>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label" for="WorkedDate">If yes, when?</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field If yes, when? must be a date." id="WorkedDate" name="WorkedDate" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="WorkedDate" data-valmsg-replace="true"></span>
</div>
</div>
<div class="col-12">
<div class="card">
<div class="card-header p-2">
<b>CDL INFORMATION</b>
</div>
<div class="card-body">
<div class="row">
<div class="form-group col-md-4">
<label class="control-label required" for="LicenseNumber">License Number</label>
<input class="form-control text-box single-line" id="LicenseNumber" name="LicenseNumber" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="LicenseNumber" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-4">
<label class="control-label required" for="LicenseState">State</label>
<input class="form-control text-box single-line" id="LicenseState" name="LicenseState" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="LicenseState" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-4">
<label class="control-label required" for="Endorsements">Endorsements</label>
<input class="form-control text-box single-line" id="Endorsements" name="Endorsements" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="Endorsements" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-4">
<label class="control-label required" for="LicenseIssueDate">Issue date</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field Issue date must be a date." id="LicenseIssueDate" name="LicenseIssueDate" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="LicenseIssueDate" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-4">
<label class="control-label required" for="LicenseExpiration">Expiration Date (License)</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field Expiration Date (License) must be a date." id="LicenseExpiration" name="LicenseExpiration" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="LicenseExpiration" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-4">
<label class="control-label required" for="HMExpiration">Expiration Date (HM end.)</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field Expiration Date (HM end.) must be a date." id="HMExpiration" name="HMExpiration" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="HMExpiration" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row pl-3 pr-3">
<label class="control-label" for="EnhancedLicense">Do you have an enhanced license?</label>
<label class="radio-inline">Yes </label> <input class="form-control" id="EnhancedLicense" name="EnhancedLicense" type="radio" value="True">
<label class="radio-inline">No </label><input htmlattributes="{ class = form-control }" id="EnhancedLicense" name="EnhancedLicense" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="EnhancedLicense" data-valmsg-replace="true"></span>
</div>
</div>
</div>
<div class="card mt-3">
<div class="card-header p-2">
<b>Other – Credential Information</b>
</div>
<div class="card-body">
<div class="row">
<div class="form-group col-md-6">
<label class="control-label required" for="TwicExpiration">TWIC Card Expiration Date</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field TWIC Card Expiration Date must be a date." id="TwicExpiration" name="TwicExpiration" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="TwicExpiration" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label required" for="FastExpiration">FAST Card Expiration Date</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field FAST Card Expiration Date must be a date." id="FastExpiration" name="FastExpiration" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="FastExpiration" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label" for="PassportCountry">Passport (country of issue)</label>
<input class="form-control text-box single-line" data-val="true" data-val-length="Passport (country of issue) must be 50 characters or less" data-val-length-max="50" id="PassportCountry" name="PassportCountry" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PassportCountry" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label" for="PassportExpiration">Passport Expiration Date</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field Passport Expiration Date must be a date." id="PassportExpiration" name="PassportExpiration" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="PassportExpiration" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-12">
<label class="control-label" for="OthersList">Others (List)</label>
<input class="form-control text-box single-line" id="OthersList" name="OthersList" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="OthersList" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
<div class="card mt-3">
<div class="card-header p-2">
<b>Pre-employment drug test notification</b>
</div>
<div class="card-body">
<b><i>Per FMCSA regulation, all CDL driver applicants must be drug tested, and a 5-panel negative result received by the employer, before being assigned to a safety sensitive position. Your signature below acknowledges that you have been notified of this requirement, and will be sent for testing. </i></b>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label required" for="CdlSignature">Signature</label>
<input class="form-control text-box single-line" data-val="true" data-val-length="Signature must be 250 characters or less" data-val-length-max="250" id="CdlSignature" name="CdlSignature" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="CdlSignature" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label required" for="CdlDate">Date</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field Date must be a date." id="CdlDate" name="CdlDate" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="CdlDate" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
</div>
<div class="col-12 mt-3">
<div class="alert-warning">
<p class="text-center">Employment History</p>
<p>List in reverse order your employment history for the past 10 years. If work history is not that long, list back to the first job and annotate in the margins that this was your first position. </p>
</div>
</div>
<div id="divHistoryDrivers">
<div class="historyDriversList">
<div id="employment_1" class="card mb-3">
<div class="card-header p-2">
<div class="pull-left h4 p-2 m-0">#1</div>
</div>
<div class="card-body">
<div class="row">
<div class="form-group col-lg-6">
<label class="control-label col-md-12" for="EmployerNameDriver">Employer Name</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryDrivers_0__EmployerNameDriver" name="EmploymentHistoryDrivers[0].EmployerNameDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryDrivers[0].EmployerNameDriver" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-6">
<label class="control-label col-md-12" for="ContactPersonDriver">Contact Person</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryDrivers_0__ContactPersonDriver" name="EmploymentHistoryDrivers[0].ContactPersonDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryDrivers[0].ContactPersonDriver" data-valmsg-replace="true"></span>
</div>
</div>
</div>
<div class="row">
<div class="form-group col-lg-6">
<label class="control-label col-md-12" for="AddressDriver">Address</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryDrivers_0__AddressDriver" name="EmploymentHistoryDrivers[0].AddressDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryDrivers[0].AddressDriver" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-6">
<label class="control-label col-md-12" for="PhoneDriver">Phone</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryDrivers_0__PhoneDriver" name="EmploymentHistoryDrivers[0].PhoneDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryDrivers[0].PhoneDriver" data-valmsg-replace="true"></span>
</div>
</div>
</div>
<div class="row">
<div class="form-group col-lg-4">
<label class="control-label col-md-12" for="PositionHeldDriver">Position Held</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryDrivers_0__PositionHeldDriver" name="EmploymentHistoryDrivers[0].PositionHeldDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryDrivers[0].PositinHeldDriver" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<label class="control-label col-md-12" for="DotRegulated">DOT Regulated?</label>
<label class="radio-inline">Yes </label><input class="form-control" id="EmploymentHistoryDrivers_0__DotRegulated" name="EmploymentHistoryDrivers[0].DotRegulated" type="radio" value="True">
<label class="radio-inline">No </label><input class="form-control" id="EmploymentHistoryDrivers_0__DotRegulated" name="EmploymentHistoryDrivers[0].DotRegulated" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryDrivers[0].DotRegulated" data-valmsg-replace="true"></span>
</div>
<div class="row">
<label class="control-label col-md-12" for="DotSafetySensitivePosition">DOT Safety Sensitive position which required drug and alcohol testing?</label>
<label class="radio-inline">Yes </label><input class="form-control" id="EmploymentHistoryDrivers_0__DotSafetySensitivePosition" name="EmploymentHistoryDrivers[0].DotSafetySensitivePosition" type="radio" value="True">
<label class="radio-inline">No </label><input class="form-control" id="EmploymentHistoryDrivers_0__DotSafetySensitivePosition" name="EmploymentHistoryDrivers[0].DotSafetySensitivePosition" type="radio" value="False">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryDrivers[0].DotSafetySensitivePosition" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="StartEmploymentDriver">Date of Employment Start</label>
<div class="col-md-12">
<input class="form-control date-control flatpickr-input" id="EmploymentHistoryDrivers_0__StartEmploymentDriver" name="EmploymentHistoryDrivers[0].StartEmploymentDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryDrivers[0].StartEmploymentDriver" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="EndEmploymentDriver">Date of Employment End</label>
<div class="col-md-12">
<input class="form-control date-control flatpickr-input" id="EmploymentHistoryDrivers_0__EndEmploymentDriver" name="EmploymentHistoryDrivers[0].EndEmploymentDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryDrivers[0].EndEmploymentDriver" data-valmsg-replace="true"></span>
</div>
</div>
</div>
<div class="row">
<div class="form-group col-lg-12">
<label class="control-label col-md-12" for="ReasonForLeavingDriver">Reason for leaving</label>
<div class="col-md-12">
<input class="form-control" id="EmploymentHistoryDrivers_0__ReasonForLeavingDriver" name="EmploymentHistoryDrivers[0].ReasonForLeavingDriver" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="EmploymentHistoryDrivers[0].ReasonForLeavingDriver" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
</div>
<script>
$(function() {
// For todays date;
Date.prototype.today = function() {
return (((this.getMonth() + 1) < 10) ? "0" : "") + (this.getMonth() + 1) + "/" + ((this.getDate() < 10) ? "0" : "") + this.getDate() + "/" + this.getFullYear();
}
var newDate = new Date();
flatpickr("#employment_1 .date-control", {
//"plugins": [new rangePlugin({ input: "#End" })],
enableTime: false,
dateFormat: "m-d-Y", // h:i"
allowInput: true
});
});
</script>
</div>
<div class="row">
<div class="form-group col-lg-12">
<div class="col-md-12">
<input type="button" id="btnAddEmployerDriver" class="btn btn-primary" value="Add Another Employer" data-row-count="1">
</div>
</div>
</div>
</div>
<div class="col-12 mt-3">
<div class="alert-warning">
<p>Driving Experience</p>
</div>
</div>
<div id="divDriverExperience">
<div class="driverExperienceList">
<div id="driverexperience_1" class="card mb-3">
<div class="card-header p-2">
<div class="pull-left h4 p-2 m-0">#1</div>
</div>
<div class="card-body">
<div class="row col-md-12">
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="TypeOfEquipment">Type of Equipment</label>
<div class="col-md-12">
<input class="form-control" id="DriverExperiences_0__TypeOfEquipment" name="DriverExperiences[0].TypeOfEquipment" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="DriverExperiences[0].TypeOfEquipment" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="DateOperatedStart">Dates Operated Start</label>
<div class="col-md-12">
<input class="form-control date-control flatpickr-input" id="DriverExperiences_0__DateOperatedStart" name="DriverExperiences[0].DateOperatedStart" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="DriverExperiences[0].DateOperatedStart" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="DateOperatedEnd">Dates Operated End</label>
<div class="col-md-12">
<input class="form-control date-control flatpickr-input" id="DriverExperiences_0__DateOperatedEnd" name="DriverExperiences[0].DateOperatedEnd" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="DriverExperiences[0].DateOperatedEnd" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="MilesRun">Miles Run</label>
<div class="col-md-12">
<input class="form-control" id="DriverExperiences_0__MilesRun" name="DriverExperiences[0].MilesRun" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="DriverExperiences[0].MilesRun" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
</div>
<script>
$(function() {
// For todays date;
Date.prototype.today = function() {
return (((this.getMonth() + 1) < 10) ? "0" : "") + (this.getMonth() + 1) + "/" + ((this.getDate() < 10) ? "0" : "") + this.getDate() + "/" + this.getFullYear();
}
var newDate = new Date();
flatpickr("#driverexperience_1 .date-control", {
//"plugins": [new rangePlugin({ input: "#End" })],
enableTime: false,
dateFormat: "m-d-Y", // h:i"
allowInput: true
});
});
</script>
</div>
<div class="row">
<div class="form-group col-lg-12">
<div class="col-md-12">
<input type="button" id="btnAddDriverExperience" class="btn btn-primary" value="Add Another Experience" data-row-count="1">
</div>
</div>
</div>
</div>
<div class="row">
<div class="form-group col-md-12">
<label class="control-label" for="StatesOperated">What States have you operated in?</label>
<input class="form-control text-box single-line" data-val="true" data-val-length="States operated in must be 1000 characters or less" data-val-length-max="1000" id="StatesOperated" name="StatesOperated" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="StatesOperated" data-valmsg-replace="true"></span>
</div>
</div>
<div class="col-12 mt-3">
<div class="alert-warning">
<p>List Traffic Convictions for the past 3 years (exclude parking tickets)</p>
</div>
</div>
<div id="divTrafficConvictions">
<div class="trafficConvictionsList">
<div id="trafficconvictions_1" class="card mb-3">
<div class="card-header p-2">
<div class="pull-left h4 p-2 m-0">#1</div>
</div>
<div class="card-body">
<div class="row">
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="ConvictionLocation">Location</label>
<div class="col-md-12">
<input class="form-control" id="TrafficConvictions_0__ConvictionLocation" name="TrafficConvictions[0].ConvictionLocation" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="HistoryConvictions[0].ConvictionLocation" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="ConvictionDate">Date</label>
<div class="col-md-12">
<input class="form-control date-control flatpickr-input" id="TrafficConvictions_0__ConvictionDate" name="TrafficConvictions[0].ConvictionDate" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="TrafficConvictions[0].ConvictionDate" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="Charge">Charge</label>
<div class="col-md-12">
<input class="form-control" id="TrafficConvictions_0__Charge" name="TrafficConvictions[0].Charge" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="TrafficConvictions[0].Charge" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-3">
<label class="control-label col-md-12" for="Penalty">Penalty</label>
<div class="col-md-12">
<input class="form-control" id="TrafficConvictions_0__Penalty" name="TrafficConvictions[0].Penalty" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="TrafficConvictions[0].Penalty" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
</div>
<script>
$(function() {
// For todays date;
Date.prototype.today = function() {
return (((this.getMonth() + 1) < 10) ? "0" : "") + (this.getMonth() + 1) + "/" + ((this.getDate() < 10) ? "0" : "") + this.getDate() + "/" + this.getFullYear();
}
var newDate = new Date();
flatpickr("#trafficconvictions_1 .date-control", {
//"plugins": [new rangePlugin({ input: "#End" })],
enableTime: false,
dateFormat: "m-d-Y", // h:i"
allowInput: true
});
});
</script>
</div>
<div class="row">
<div class="form-group col-lg-12">
<div class="col-md-12">
<input type="button" id="btnAddTrafficConviction" class="btn btn-primary" value="Add Another Traffic Conviction" data-row-count="1">
</div>
</div>
</div>
</div>
<div class="col-12 mt-3">
<div class="alert-warning">
<p>List any accidents that you have been involved in within the past 3 years</p>
</div>
</div>
<div id="divAccidents">
<div class="accidentsList">
<div id="accidents_1" class="card mb-3">
<div class="card-header p-2">
<div class="pull-left h4 p-2 m-0">#1</div>
</div>
<div class="card-body">
<div class="row">
<div class="form-group col-lg-6">
<label class="control-label col-md-12" for="AccidentLocation">Location</label>
<div class="col-md-12">
<input class="form-control" id="Accidents_0__AccidentLocation" name="Accidents[0].AccidentLocation" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="Accidents[0].AccidentLocation" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-6">
<label class="control-label col-md-12" for="AccidentDate">Date</label>
<div class="col-md-12">
<input class="form-control date-control flatpickr-input" id="Accidents_0__AccidentDate" name="Accidents[0].AccidentDate" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="Accidents[0].AccidentDate" data-valmsg-replace="true"></span>
</div>
</div>
</div>
<div class="row">
<div class="form-group col-lg-6">
<label class="control-label col-md-12" for="AccidentType">Type</label>
<div class="col-md-12">
<input class="form-control" id="Accidents_0__AccidentType" name="Accidents[0].AccidentType" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="Accidents[0].AccidentType" data-valmsg-replace="true"></span>
</div>
</div>
<div class="form-group col-lg-6">
<label class="control-label col-md-12" for="InjuriesFatalities">Injuries/Fatalities</label>
<div class="col-md-12">
<input class="form-control" id="Accidents_0__InjuriesFatalities" name="Accidents[0].InjuriesFatalities" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="Accidents[0].InjuriesFatalities" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
</div>
<script>
$(function() {
// For todays date;
Date.prototype.today = function() {
return (((this.getMonth() + 1) < 10) ? "0" : "") + (this.getMonth() + 1) + "/" + ((this.getDate() < 10) ? "0" : "") + this.getDate() + "/" + this.getFullYear();
}
var newDate = new Date();
flatpickr("#accidents_1 .date-control", {
//"plugins": [new rangePlugin({ input: "#End" })],
enableTime: false,
dateFormat: "m-d-Y", // h:i"
allowInput: true
});
});
</script>
</div>
<div class="row">
<div class="form-group col-lg-12">
<div class="col-md-12">
<input type="button" id="btnAddAccident" class="btn btn-primary" value="Add Another Accident" data-row-count="1">
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-12">
<div class="alert-warning">
<p class="text-center">Hiring Policy- Driver Applicants</p>
<p> Applicant must:<br> 1. Be at least 23 years old<br> 2. Have at least one full year of verifiable experience driving tractor/trailer<br> 3. Hold a valid Commercial Driver’s License (CDL), class A, with X (Tank & Hazmat)
endorsement<br> 4. Not be currently disqualified, for any reason, from driving a Commercial Motor Vehicle (CMV)<br> 5. Have a currently valid DOT physical<br> 6. Account completely and accurately for all employment for the preceding
10 years.<br> 7. Be qualified under all FMCSR standards for CMV operators<br> 8. Not have any past convictions for DWI, DWAI, or DUI </p>
<p> Pre-hire procedure:<br> 1. Application filled out on Terpening premises<br> 2. Interview with Terpening management<br> 3. Road test by safety coordinator or his designated substitute<br> 4. MVR check, violation certification, and
past employment check<br> 5. Review of long form of DOT physical (provided by applicant)<br> 6. Drug Screen </p>
<p>Job Description: </p>
<ul class="list-group">
<li class="alert-warning mt-1 mb-1"> The applicant must be qualified to drive a tractor/tank semi-trailer combination, hauling placarded hazardous materials, in interstate commerce. Additional responsibilities and duties shall
include, at a minimum: <ul class="alert-warning mt-1 mb-1">
<li class="alert-warning mt-1 mb-1"> All DOT-mandated procedures and paperwork;<br> Loading and unloading procedures for tank trailers;<br> Terpening paperwork; Adherence to work schedule as set by Terpening dispatch </li>
</ul>
</li>
</ul>
<p>A copy pf the complete Driver’s Job Description and Company Policy will be provided at the applicant’s request. </p>
<p><b><i>“I have read the above. I understand that any falsification or omission of information on this application may result in termination of any consideration for employment.” </i></b></p>
</div>
</div>
<div class="row col-md-12">
<div class="form-group col-md-6">
<label class="control-label required" for="HiringPolicyDate">Date</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field Date must be a date." id="HiringPolicyDate" name="HiringPolicyDate" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="HiringPolicyDate" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label required" for="HiringPolicySignature">Signature</label>
<input class="form-control text-box single-line" id="HiringPolicySignature" name="HiringPolicySignature" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="HiringPolicySignature" data-valmsg-replace="true"></span>
</div>
</div>
</div>
<div class="row">
<div class="col-12">
<div class="alert-warning">
<p class="text-center">Notification of Driver’s Rights</p>
<p> In accordance with Federal Motor Carrier Safety Administration regulation 391.23 (i)(1), we are required to make known to Driver applicants for employment with our company that you have the following rights regarding the
investigative information that will be provided to our company pursuant to paragraphs (d) and (e) of this section of the regulation. </p>
<p> 1.) You have the right to review information provided by your previous employers <br> 2.) You have the right to have errors in the information corrected by the previous employer and for that previous employer to re-send the
corrected information to our company.<br> 3.) You have the right to have a rebuttal statement attached to the alleged erroneous information if the previous employer and the driver cannot agree on the accuracy of the information. </p>
<p><b><i>“I understand that I have been informed of these rights in accordance to the above listed regulation.”</i></b></p>
</div>
</div>
<div class="row col-md-12">
<div class="form-group col-md-6">
<label class="control-label required" for="DriversRightsDate">Date</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field Date must be a date." id="DriversRightsDate" name="DriversRightsDate" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="DriversRightsDate" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label required" for="DriversRightsSignature">Signature</label>
<input class="form-control text-box single-line" id="DriversRightsSignature" name="DriversRightsSignature" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="DriversRightsSignature" data-valmsg-replace="true"></span>
</div>
</div>
</div>
<div class="row">
<div class="card mt-3">
<div class="card-header p-2">
<b>To be read and signed by the applicant</b>
</div>
<div class="card-body">
<i>This certifies that this application was completed by me, and that all entries on it and information within are true and complete to the best of my knowledge. It is also understood that the company will contact my previous employers and verify the information on this application as required by Federal and State DOT. </i>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label required" for="DriverAppDate">Date</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field Date must be a date." id="DriverAppDate" name="DriverAppDate" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="DriverAppDate" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label required" for="DriverSignature">Applicant Signature</label>
<input class="form-control text-box single-line" id="DriverSignature" name="DriverSignature" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="DriverSignature" data-valmsg-replace="true"></span>
</div>
</div>
</div>
</div>
</div>
</section>
</fieldset>
<h3 id="frmApplication-h-4" tabindex="-1" class="title">Applicant Certification</h3>
<fieldset id="frmApplication-p-4" role="tabpanel" aria-labelledby="frmApplication-h-4" class="body" aria-hidden="true" style="display: none;">
<legend></legend>
<section>
<div class="col-12">
<div class="alert-warning">
<p>I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver’s license for the state in which I reside and automobile
liability insurance in an amount equal to the minimum required by the state where I reside.</p>
<p>I understand that the company may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state and local law. If the company has such a program and I am offered a
conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace,
consistent with applicable federal, state, and local law.</p>
<p>If employed by the Company, I understand and agree that the company, to the extent permitted by federal, state, and local law, may exercise its right, without prior notice or warning, to conduct investigations of property (including,
but not limited to, files, lockers, desks, vehicles and computers) and, in certain circumstances, my personal property.</p>
<p>I understand and agree that as a condition of employment and to the extent permitted by federal, state and local law, I may be required to sign a confidentiality, restrictive covenant, and/or conflict of interest statement, as well as
an agreement to arbitrate.</p>
<p>I certify that all the information on this application, my resume, or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification,
misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal.</p>
<p>THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELAIONSHIPAT ANY TIME, FOR ANY REASON,
WITH OR WITHOU CAUSE OR NOTICE. NOTHING IN THIS APPLICATION OR IN ANY DOCUMENT OR STATEMENT, WRITTEN OR ORAL, SHALL LIMIT THE RIGHT TO TERMINATE EMPLOYMENT AT-WILL. NO OFFICER, EMPLOYEE OR REPRESENTATIVE OF THE COMPANY IS AUTHORIZED TO
ENTER AN AGREEMENT-EXPRESS OR IMPLIED- WITH ME OR ANY APPLICANT FOR EMPLOYMENT FOR A SPECIFIED PERIOD OF TIME UNLESS SUCH AN AGREEMENT IS IN A WRITTEN CONTRACT SIGNED BY THE PRESIDENT OF THE COMPANY.</p>
<p>IF HIRED, I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF THE COMPANY, AND I UNDERSTAND THAT THE COMPANY HAS COMPLETE DISCRETION TO MODIFY SUCH RULES AND REGULATIONS AT ANY TIME, EXCPET THAT IT WILL NOT MODIFY ITS POLICY OF
EMPLOYMENT AT-WILL. </p>
<p>I authorize the company or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking and to the extent permitted by federal, state or local law. I agree to comply any
requisite authorization forms for the background investigation.</p>
<p>I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above-mentioned information. I hereby release, discharge, and hold harmless, to the extent permitted by federal, state and
local law, any party delivering information to the company or its duly authorized representative pursuant to this authorization from any liability, claims, charges, or causes of action which I may have as a result of the delivery or
disclosure of the above requested information. I hereby release from liability the Company and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information.</p>
<p>If hired by this Company, I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States by this company. I also understand this Company
employs only individuals who are legally eligible to work in the United States.</p>
<p>THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF SIXTY (60) DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY.</p>
<p>I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE, ACCURATE, AND COMPLETE. </p>
</div>
</div>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label required" for="ApplicantSignature">Applicant Signature</label>
<input class="form-control text-box single-line" id="ApplicantSignature" name="ApplicantSignature" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="ApplicantSignature" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label required" for="ApplicantDate">Date</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field Date must be a date." id="ApplicantDate" name="ApplicantDate" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="ApplicantDate" data-valmsg-replace="true"></span>
</div>
</div>
<div class="col-12">
<div class="alert-warning">
<p>If the applicant is a minor, the foregoing release and consent must be signed by the applicant’s parent or legal guardian. Signature by the applicants parent or legal guardian constitutes acknowledgement by the applicant and the parent
or legal guardian that the Company, to the extent permitted by federal, state, and local law, can test the applicant for illegal or controlled substances, conduct inspections of property without notice, and communicate test results to
Company personnel who need to know, the applicant, and the applicant’s legal guardian. </p>
</div>
</div>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label" for="Parent">Parent/Legal Guardian</label>
<input class="form-control text-box single-line" id="Parent" name="Parent" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="Parent" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label" for="ParentDate">Date</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field Date must be a date." id="ParentDate" name="ParentDate" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="ParentDate" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label" for="Witness">Witness</label>
<input class="form-control text-box single-line" id="Witness" name="Witness" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="Witness" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label" for="WitnessDate">Date</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field Date must be a date." id="WitnessDate" name="WitnessDate" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="WitnessDate" data-valmsg-replace="true"></span>
</div>
</div>
<div class="col-12">
<div class="alert-warning">
<p>UNDER MARYLAND LAW, AN EMPLOYER MAY NOT RQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DET ECTOR, POLYGRAPH OR SIMILAR TEST. AN EMPLOYER WHO
VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100. I have read and understand the above statement. </p>
</div>
</div>
<div class="col-12">
<div class="alert-warning">
<p> UNDER MASSACHUSETTS LAW, IT IS UNLAWFUL FOR AN EMPLOYER TO RWQUIRE OR TO ADMINISTER A LIE DETECTOR, POLYGRAPH OR SIMILAR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. FEDERAL AND/OR STATE LAW MAY PROHIBIT THE USE OF A LIE
DETECTOR, POLYGRAPH OR SIMILAR TEST AS WELL. THIS APPLICATION MAY NOT BE APPLICABLE FOR ALL INDUSTRIES. </p>
</div>
</div>
<div class="row">
<div class="form-group col-md-6">
<label class="control-label" for="ApplicantSignatureMaryland">Applicant Signature</label>
<input class="form-control text-box single-line" id="ApplicantSignatureMaryland" name="ApplicantSignatureMaryland" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="ApplicantSignatureMaryland" data-valmsg-replace="true"></span>
</div>
<div class="form-group col-md-6">
<label class="control-label" for="ApplicantDateMaryland">Date</label>
<input class="form-control text-box single-line flatpickr-input" data-val="true" data-val-date="The field Date must be a date." id="ApplicantDateMaryland" name="ApplicantDateMaryland" type="text" value="">
<span class="field-validation-valid text-danger" data-valmsg-for="ApplicantDateMaryland" data-valmsg-replace="true"></span>
</div>
</div>
<div class="row">
<div class="form-group col-lg-12">
<div class="col-md-12 text-center">
<div>
<div class="grecaptcha-badge" data-style="bottomright"
style="width: 256px; height: 60px; display: block; transition: right 0.3s ease 0s; position: fixed; bottom: 14px; right: -186px; box-shadow: gray 0px 0px 5px; border-radius: 2px; overflow: hidden;">
<div class="grecaptcha-logo"><iframe title="reCAPTCHA"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LflFJgUAAAAACZLl5ZfbyMXvNFvNQqGasfQlLAa&co=aHR0cHM6Ly9hcHBseS50ZXJwZW5pbmd0cnVja2luZy5jb206NDQz&hl=de&v=1B_yv3CBEV10KtI2HJ6eEXhJ&size=invisible&cb=1wtet1jcioje"
width="256" height="60" role="presentation" name="a-rzr7gojzo7a7" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div>
<div class="grecaptcha-error"></div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
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Cookie Policy
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* current step: 1. Contact Info
* 2. Shift Policy
* 3. Non-Driver Application
* 4. CDL Driver Application
* 5. Applicant Certification
CONTACT INFO
Please Answer All Questions. Resumes Are Not a Substitute for a Completed
Application
We are an equal opportunity employer. Applicants are considered for positions
without regard to veteran status, uniformed service member status, race,
religion, sex, national origin, age, physical or mental disability, genetic
information or any other category protected by applicable federal, state or
local laws.
THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS
MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE
COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY
REASON, WITH OR WITHOUT CAUSE OR NOTICE.
POSITION
DRIVER APPLICANTS WILL NOT NEED TO COMPLETE STEP 3
NON-DRIVER APPLICANTS WILL NOT NEED TO COMPLETE STEP 4
CDL Driver
Non-Driver
Position Applied For
Name
Email
Telephone Number
Alternate or Cell Telephone Number
Present Address
City
State
Zip
How long have you lived there?
Previous Address
City
State
Zip
How long have you lived there?
Date on which you can start work if hired
Desired Salary/Hourly Rate
TYPE OF EMPLOYMENT DESIRED?
Full-Time
Part-Time
(Specify Hours)
Are you willing to work overtime? Yes No
If under the age of 18, Can you produce the necessary work certificate at time
of employment? Yes No
Have you previously applied for employment with this Company? Yes No
If yes, when and where did you apply?
Have you ever been employed by this Company? Yes No
If Yes, provide dates of employment, location, and reason for separation from
employment.
INSTRUCTIONS FOR ANSWERING THE NEXT TWO QUESTIONS
1. All applicants: Do not include convictions that were sealed; eradicated,
erased; annulled by a court, or expunged, or convictions that resulted in
referral to a diversion program.
2. Arizona, Colorado, District of Columbia, Illinois, Kansas, Minnesota,
Missouri, Montana, Nevada, Rhode Island, South Carolina and Utah applicants: Do
not respond to the second question regarding arrests.
3. California applicants: Do not include misdemeanor marijuana-related
convictions that are more than two (2) years old or misdemeanor convictions for
which probation was successfully completed or otherwise discharged and the case
was judicially dismissed.
4. Connecticut applicants: You are not required to disclose the existence of any
arrest, criminal charge, or conviction, the records of which have been erased.
Criminal records subject to erasure are records pertaining to a finding of
delinquency or the fact that a chl1d was a member of a family with service
needs, an adjudication as a youthful offender, a criminal charge that has been
dismissed or knolled (not prosecuted), a criminal charge for which the person
was found not guilty, or a conviction for which the offender received An
absolute pardon. Any person whose criminal records have been erased is deemed to
have never been arrested within the meaning of The law as it applies to the
particular proceedings that have been erased, and may so swear under oath.
5. District of Columbia and Washington applicants: Limit any response to the
past ten (10) years.
6. Hawaii and Massachusetts applicants; Do not answer the following two
questions.
7. Indiana applicants: Regarding arrests limit your response to pending charges
for felonies and class A misdemeanors that are less than One (1)
8. Michigan applicants: Regarding arrests, limit your response to felony arrests
awaiting conviction or dismissal.
9. New York applicants: All pending arrests or criminal accusations must be
disclosed. You are not required to disclose arrests or criminal accusations at
resulted in criminal actions or proceeding which were terminated in your favor.
Do not disclose criminal actions or proceedings that were sealed or classified
as youthful offender adjudications. An ex-offender who is denied employment may,
upon written request, receive a statement of the reason(s) for denial within
thirty (30) days of the applicant's request for such information.
10. North Dakota and Oregon applicants: Regarding arrests, limit your response
to pending charges that are less than one (1) year old.
11. Utah applicants; Limit any response to felony convictions only. Do not
respond to the second question regarding arrests.
Have you ever plead guilty or no contest to, or been convicted of any criminal
offense other than the applicable exceptions listed above? Yes No
Have you ever been arrested for any matters for which you currently are out on
bail or on your own recognizance pending? Yes No
Criminal OFFENSES ONLY: If you answered Yes, to either of the above two
questions, please provide the date(s) and explain in accordance with the above
instructions so that individual circumstances can be considered.
Criminal convictions or arrests will not automatically disqualify an applicant
from a particular job. The Company will consider the nature of the crime, its
seriousness, the substantial relation to the position's functions and
qualifications, the number of occurrences, the applicant's age at the time of
the crime, the time elapsed since the crime, the applicant's entire work and
educational history, employment references and recommendations, and the business
necessity of any exclusion when required by law.
Have you ever initiated an act of violence in the workplace? Yes No
If yes, please provide the date(s) and explain so that individual circumstances
can be considered. (A 'Yes' answer will not necessarily disqualify you from
employment)
List all special technical skills that you feel qualify you for the job for
which you are applying (For example, computer programming/language, software,
equipment operation, special tools or machines, etc.)
HIGH SCHOOL
School Name and Location
Course of Study
Did You Graduate?
Yes No
Years Completed
COLLEGE
School Name and Location
Course of Study
Did You Graduate?
Yes No
Years Completed
Degree/Major
BUS/TECH/TRADE OR POST COLLEGE
School Name and Location
Course of Study
Did You Graduate?
Yes No
Years Completed
Degree/Major
Honors Received
If applicable, list below any other names by which you have been known which may
be necessary to allow us to confirm your work and educational record.For
example, change of name, use of an assumed name, nickname, etc.
REFERENCES
Please list the names of additional work-related references we may contact.
Individuals with no prior work experience may list school or volunteer-related
references.
REFERENCE 1
Name
Position
Company
Telephone
Work Relationship (i.e Supervisor, Co-worker)
REFERENCE 2
Name
Position
Company
Telephone
Work Relationship (i.e Supervisor, Co-worker)
Please list the names of personal references (not previous employers or
relatives) who know you well that we may contact.
PERSONAL REFERENCE 1
Name
Occupation
Telephone
Number of Years Known
Address
PERSONAL REFERENCE 2
Name
Occupation
Telephone
Number of Years Known
Address
SHIFT POLICY
AGREEMENT TO ACCEPT NIGHT AND WEEKEND WORK
Applicant:
A second shift is required to meet our present needs. All new employees are
hired with the understanding that they are able and willing to work nights and
weekends.
Please answer the following:
1) Do you have any physical condition that would prevent You from working
nights? Yes No
2) Do you know of any personal reasons that would Interfere with your working
nights and weekends ? Yes No
3) Are you willing to work nights and weekends? Yes No
I understand that any employment is conditioned upon my acceptance of a night
and weekend assignment.
Signed
Dated
In the presence of
NON-DRIVER APPLICATION
THIS PAGE TO BE FILLED OUT BY NON-DRIVER APPLICANTS ONLY
Please list the names of your present and/or previous employers in chronological
order with present or last employer list first. Account for all periods of time
including any period of unemployment. If self-employed, supply firm name and
business references. You may include any verifiable work performed on a
volunteer basis, internships, or military service. Your failure to completely
respond to each inquiry my disqualify you for consideration from employment.
#1
Employer
Address
Telephone
Type of Business
Job Title
Date Employed From
Date Employed To
Duties
Supervisor's Name
May we contact? Yes No
If No, Why not?
Wages Start
Wages Final
What will this employer say was the reason for your employment terminated?
How much notice did you give when resigning? If none, explain
Reason for Leaving
Please explain fully all gaps in your employment history in excess of one month.
Have you ever been terminated or asked to resign from any job? Yes No
If yes, how many times?
Has your employment ever been terminated by mutual agreement? Yes No
If yes, how many times?
Have you ever been given the choice to resign rather than be terminated? Yes
No
If yes, how many times?
If you answered YES to any of the above questions, please explain the
circumstances of EACH occasion.
CDL DRIVER APPLICATION
APPLICATION FOR EMPLOYMENT- CDL DRIVERS ONLY
We are an equal opportunity employer. Applicants are considered for positions
without regard to veteran status, uniformed member service, race, religion, sex,
national origin, age, genetic information, or any other category protected by
applicable federal, state or local laws. Terpening Trucking Co., Inc. is at
at-will employer as allowed by applicable state law. This means regardless of
any provision in this application, if hired, the Company or the employee may
terminate the employment relationship at any time, for any reason, without cause
or notice. As Terpening Trucking is a DOT-Regulated Carrier, all applicants must
be qualified under all applicable DOT regulations.
Name
DOB
Have you previously applied to Terpening Trucking? Yes No
If yes, when?
Have you previously worked for Terpening Trucking? Yes No
If yes, when?
CDL INFORMATION
License Number
State
Endorsements
Issue date
Expiration Date (License)
Expiration Date (HM end.)
Do you have an enhanced license? Yes No
Other – Credential Information
TWIC Card Expiration Date
FAST Card Expiration Date
Passport (country of issue)
Passport Expiration Date
Others (List)
Pre-employment drug test notification
Per FMCSA regulation, all CDL driver applicants must be drug tested, and a
5-panel negative result received by the employer, before being assigned to a
safety sensitive position. Your signature below acknowledges that you have been
notified of this requirement, and will be sent for testing.
Signature
Date
Employment History
List in reverse order your employment history for the past 10 years. If work
history is not that long, list back to the first job and annotate in the margins
that this was your first position.
#1
Employer Name
Contact Person
Address
Phone
Position Held
DOT Regulated? Yes No
DOT Safety Sensitive position which required drug and alcohol testing? Yes No
Date of Employment Start
Date of Employment End
Reason for leaving
Driving Experience
#1
Type of Equipment
Dates Operated Start
Dates Operated End
Miles Run
What States have you operated in?
List Traffic Convictions for the past 3 years (exclude parking tickets)
#1
Location
Date
Charge
Penalty
List any accidents that you have been involved in within the past 3 years
#1
Location
Date
Type
Injuries/Fatalities
Hiring Policy- Driver Applicants
Applicant must:
1. Be at least 23 years old
2. Have at least one full year of verifiable experience driving tractor/trailer
3. Hold a valid Commercial Driver’s License (CDL), class A, with X (Tank &
Hazmat) endorsement
4. Not be currently disqualified, for any reason, from driving a Commercial
Motor Vehicle (CMV)
5. Have a currently valid DOT physical
6. Account completely and accurately for all employment for the preceding 10
years.
7. Be qualified under all FMCSR standards for CMV operators
8. Not have any past convictions for DWI, DWAI, or DUI
Pre-hire procedure:
1. Application filled out on Terpening premises
2. Interview with Terpening management
3. Road test by safety coordinator or his designated substitute
4. MVR check, violation certification, and past employment check
5. Review of long form of DOT physical (provided by applicant)
6. Drug Screen
Job Description:
* The applicant must be qualified to drive a tractor/tank semi-trailer
combination, hauling placarded hazardous materials, in interstate commerce.
Additional responsibilities and duties shall include, at a minimum:
* All DOT-mandated procedures and paperwork;
Loading and unloading procedures for tank trailers;
Terpening paperwork; Adherence to work schedule as set by Terpening
dispatch
A copy pf the complete Driver’s Job Description and Company Policy will be
provided at the applicant’s request.
“I have read the above. I understand that any falsification or omission of
information on this application may result in termination of any consideration
for employment.”
Date
Signature
Notification of Driver’s Rights
In accordance with Federal Motor Carrier Safety Administration regulation 391.23
(i)(1), we are required to make known to Driver applicants for employment with
our company that you have the following rights regarding the investigative
information that will be provided to our company pursuant to paragraphs (d) and
(e) of this section of the regulation.
1.) You have the right to review information provided by your previous employers
2.) You have the right to have errors in the information corrected by the
previous employer and for that previous employer to re-send the corrected
information to our company.
3.) You have the right to have a rebuttal statement attached to the alleged
erroneous information if the previous employer and the driver cannot agree on
the accuracy of the information.
“I understand that I have been informed of these rights in accordance to the
above listed regulation.”
Date
Signature
To be read and signed by the applicant
This certifies that this application was completed by me, and that all entries
on it and information within are true and complete to the best of my knowledge.
It is also understood that the company will contact my previous employers and
verify the information on this application as required by Federal and State DOT.
Date
Applicant Signature
APPLICANT CERTIFICATION
I understand and agree that if driving is a requirement of the job for which I
am applying, my employment and/or continued employment is contingent on
possessing a valid driver’s license for the state in which I reside and
automobile liability insurance in an amount equal to the minimum required by the
state where I reside.
I understand that the company may now have, or may establish, a drug-free
workplace or drug and/or alcohol testing program consistent with applicable
federal, state and local law. If the company has such a program and I am offered
a conditional offer of employment, I understand that if a pre-employment
(post-offer) drug and/or alcohol test is positive, the employment offer may be
withdrawn. I agree to work under the conditions requiring a drug-free workplace,
consistent with applicable federal, state, and local law.
If employed by the Company, I understand and agree that the company, to the
extent permitted by federal, state, and local law, may exercise its right,
without prior notice or warning, to conduct investigations of property
(including, but not limited to, files, lockers, desks, vehicles and computers)
and, in certain circumstances, my personal property.
I understand and agree that as a condition of employment and to the extent
permitted by federal, state and local law, I may be required to sign a
confidentiality, restrictive covenant, and/or conflict of interest statement, as
well as an agreement to arbitrate.
I certify that all the information on this application, my resume, or any
supporting documents I may present during any interview is and will be complete
and accurate to the best of my knowledge. I understand that any falsification,
misrepresentation, or omission of any information may result in disqualification
from consideration for employment or, if employed, disciplinary action, up to
and including immediate dismissal.
THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS
MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE
COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELAIONSHIPAT ANY TIME, FOR ANY
REASON, WITH OR WITHOU CAUSE OR NOTICE. NOTHING IN THIS APPLICATION OR IN ANY
DOCUMENT OR STATEMENT, WRITTEN OR ORAL, SHALL LIMIT THE RIGHT TO TERMINATE
EMPLOYMENT AT-WILL. NO OFFICER, EMPLOYEE OR REPRESENTATIVE OF THE COMPANY IS
AUTHORIZED TO ENTER AN AGREEMENT-EXPRESS OR IMPLIED- WITH ME OR ANY APPLICANT
FOR EMPLOYMENT FOR A SPECIFIED PERIOD OF TIME UNLESS SUCH AN AGREEMENT IS IN A
WRITTEN CONTRACT SIGNED BY THE PRESIDENT OF THE COMPANY.
IF HIRED, I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF THE COMPANY, AND I
UNDERSTAND THAT THE COMPANY HAS COMPLETE DISCRETION TO MODIFY SUCH RULES AND
REGULATIONS AT ANY TIME, EXCPET THAT IT WILL NOT MODIFY ITS POLICY OF EMPLOYMENT
AT-WILL.
I authorize the company or its agents to confirm all statements contained in
this application and/or resume as it relates to the position I am seeking and to
the extent permitted by federal, state or local law. I agree to comply any
requisite authorization forms for the background investigation.
I authorize and consent to, without reservation, any party or agency contacted
by this employer to furnish the above-mentioned information. I hereby release,
discharge, and hold harmless, to the extent permitted by federal, state and
local law, any party delivering information to the company or its duly
authorized representative pursuant to this authorization from any liability,
claims, charges, or causes of action which I may have as a result of the
delivery or disclosure of the above requested information. I hereby release from
liability the Company and its representative for seeking such information and
all other persons, corporations, or organizations furnishing such information.
If hired by this Company, I understand that I will be required to provide
genuine documentation establishing my identity and eligibility to be legally
employed in the United States by this company. I also understand this Company
employs only individuals who are legally eligible to work in the United States.
THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF SIXTY (60) DAYS. IF
YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY.
I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION
IS TRUE, ACCURATE, AND COMPLETE.
Applicant Signature
Date
If the applicant is a minor, the foregoing release and consent must be signed by
the applicant’s parent or legal guardian. Signature by the applicants parent or
legal guardian constitutes acknowledgement by the applicant and the parent or
legal guardian that the Company, to the extent permitted by federal, state, and
local law, can test the applicant for illegal or controlled substances, conduct
inspections of property without notice, and communicate test results to Company
personnel who need to know, the applicant, and the applicant’s legal guardian.
Parent/Legal Guardian
Date
Witness
Date
UNDER MARYLAND LAW, AN EMPLOYER MAY NOT RQUIRE OR DEMAND, AS A CONDITION OF
EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL
SUBMIT TO OR TAKE A LIE DET ECTOR, POLYGRAPH OR SIMILAR TEST. AN EMPLOYER WHO
VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING
$100. I have read and understand the above statement.
UNDER MASSACHUSETTS LAW, IT IS UNLAWFUL FOR AN EMPLOYER TO RWQUIRE OR TO
ADMINISTER A LIE DETECTOR, POLYGRAPH OR SIMILAR TEST AS A CONDITION OF
EMPLOYMENT OR CONTINUED EMPLOYMENT. FEDERAL AND/OR STATE LAW MAY PROHIBIT THE
USE OF A LIE DETECTOR, POLYGRAPH OR SIMILAR TEST AS WELL. THIS APPLICATION MAY
NOT BE APPLICABLE FOR ALL INDUSTRIES.
Applicant Signature
Date
Submit
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Contact Us
LOCATION
115 Farrell Road
Syracuse, NY 13209
CONTACT
DISPATCH & ALL OTHER
CALLS:(315)451-8661
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