Welcome to SunBelt

Online Application

All Fields in RED are required.

How did you find us?

If other please specify

E-Mail Address

  Send a Carbon Copy of this Application to your E-Mail Address entered above?

First Name

Middle Name

Last Name

Date of Birth11-11-1111

Social Security#111-11-1111

Address

City

State


Zip

Phone111-111-1111


Position applying for:


Year/Make of truck:

 
Drivers License Number

  State:

Exp. Date

CDL?


Endorsements?

Number of Tickets last 3 years

Number of Accidents last 3 years


DUI?

If yes, date

License suspended or revoked?

If yes, date

Convicted of a felony or misdemeanor?

If yes, date


Employment History

Showing the past three (3) years employment, and/or commercial driving experience for the past 10 years, list below past and present employers,
BEGINNING WITH YOUR PRESENT OR MOST RECENT, ALL TIMES MUST BE ACCOUNTED FOR INCLUDING UNEMPLOYMENT!

1. Dates of Employment
From

To

Employer's Name

Address



City

State

Phone

Position



# of accidents

Type of Trailer

# of States

Reason for leaving


2. Dates of Employment
From

To

Employer's Name

Address



City

State

Phone

Position



# of accidents

Type of Trailer

# of States

Reason for leaving


3. Dates of Employment
From

To

Employer's Name

Address



City

State

Phone

Position



# of accidents

Type of Trailer

# of States

Reason for leaving


4. Dates of Employment
From

To

Employer's Name

Address



City

State

Phone

Position



# of accidents

Type of Trailer

# of States

Reason for leaving


5. Dates of Employment
From

To

Employer's Name

Address



City

State

Phone

Position



# of accidents

Type of Trailer

# of States

Reason for leaving


Only fill in this box if a Recruiter has specified what you should enter.  @ats-inc.com

TERMS AND CONDITIONS FOR SUNBELT FURNITURE XPRESS (SBFX)
APPLICATION FOR CERTIFICATION
I certify that I personally completed this application and that all of the information is true and correct. I hereby request and authorize SBFX to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed this application of my own free will and hold SBFX harmless of all liability for providing this application for my use.

In connection with my application for certification (including contract for services) with you, I understand that consumer reports which may contain public record information may be requested from DAC Services, Tulsa, Oklahoma. These reports may include the following type of information: names and dates of previous employers, reason for termination of employment, work experience, accidents, etc. I further understand that such reports may contain public record information concerning my driving record, workers compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records; as well as information from DAC concerning previous driving record requests made by others from such state agencies, and state provided driving records.

I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY ATS TO FURNISH THE ABOVE-MENTIONED INFORMATION.

I have the right to make a request to DAC, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me which DAC has previously furnished within the two year period preceding my request. I hereby consent to your obtaining the above information from DAC, and I agree that such information which DAC has or obtains, and my employment history with you if I am hired, will be supplied by DAC to other companies which subscribe to DAC Services.

I hereby authorize procurement of consumer report(s). If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment (or contract) period.



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FOR PRINTED COPY, PLEASE SIGN AND DATE:

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