MTRK Employment Application

MTRK Employment Application
Metropolitan Trucking, Inc. JNM Services Metropolitan Logistics, LTD.
MTRK Metropolitan Trucking, Inc. A Family Tradition DRIVER Application for Employment
Only complete this application if applying for a driver position If applying for another position ask for non-driver application
COMPANY POLICY
Our policy prohibits discrimination based on race, color, sex, age, religion, national origin, sexual preference or orientation, handicap(which can reasonably be accommodated), union affiliation, veteran or marital status, or any other basis which is prescribed by application federal or state law. NO QUESTION SHALL BE USED FOR DISCRIMINATORY PURPOSES. Instructions to Applicant: Please print answers to EVERY QUESTION. If the answer to any question is no, check the proper box or write No. DO NOT LEAVE QUESTIONS UNANSWERED. UNANSWERED QUESTIONS MAY DISQUALIFY AN APPLICANT FROM FURTHER CONSIDERATION.
*Position applied for  
*Location  
*Email Address  
*Applicant`s Full Name  
*Social Security Number  
Phone #  
Cell Phone#  
*Date of Birth:  
*Present address  
*City  
*State:  
*Zip Code:  
*How Long?  
Prior Address  
City  
State:  
Zip Code:  
How Long?  
List below the names and telephone numbers of two people to be contacted in the event of an emergency
Name:  
Phone #  
Name  
Phone #  
How did you learn about thei position?
How did you learn about this position  
Do you have a reliable means of getting to work?
Yes
No
Are you willing to work up to 14 hours per day?
Yes
No
Have you ever served in the US Military?
served in the US Military
Yes
No
If yes give branch  
Can you perform the essential functions of the job without reasonable accommodations?
Yes
No
Have you ever been employed by MTRK or JNM Services or Metropolitan logistics or Transit management services Inc. of NJ?
Have you ever been employed by
Yes
No
Have you ever been disciplined by any of your employers during the past three years?
disciplined by any of your employers
Yes
No
If yes detail the discipline  
Do you have any relatives at MTRK
Have any relatives at MTRK
Yes
No
Are you a citizen of, or are you authorized to work, in the United States
Yes
No
Proof of citizenship or authorization will be required as a condition of hire.
Record of Education
High School Name  
City  
State:  
Grades Completed  
Business or Trade School  
College  
Additional Information:  
Record of Convictions
READ CAREFULLY: List ALL Criminal convictions which have not been cleared from your record or sealed with the Commissioner of Probation. (A conviction record will not necessarily bar an applicant from employment. Factors such as relation to the job, age and time of offense, seriousness, nature of the violation(s) and rehabilitation will be taken into account.) If None Write None (Massachusetts applicants: should not include misdemeanor convictions more than five years old)
None
Date:   mm/dd/yyyy
Type of Conviction:  
LOCATION:  
State:  
SENTENCE  
Important: Failure to list information will result in termination for false application-Be sure to list all information regardless of age.
EXPERIENCE & QUALIFICATIONS
List the states in which you have driven regularly:  
What awards, if any, do you hold for safe driving?  
Licenses: List all unexpired drivers licenses and/or permits which have been issued to you.
State:  
License Number  
Class or Type  
Expiration Date  
State:  
License Number  
Class or Type  
Expiration Date  
Additional Information:  
Traffic Violation Convictions: List ALL Traffic violations (other than parking)
Location/State:  
Date:   mm/dd/yyyy
Charge:  
Penalty / Points/Suspension, etc.  
Location/State:  
Date:   mm/dd/yyyy
Charge:  
Penalty / Points/Suspension, etc.  
Location/State:  
Date:   mm/dd/yyyy
Charge:  
Penalty / Points/Suspension, etc.  
Location/State:  
Date:   mm/dd/yyyy
Charge:  
Penalty / Points/Suspension, etc.  
Additional Information:  
Accidents: List ALL accidents by car or truck, chargeable or non-chargeable, in which you were involved.
Date:   mm/dd/yyyy
Chargeable?
Yes
No
City  
State:  
Type of Accident  
Personal Injury
Yes
No
Fatalities
Yes
No
Date:   mm/dd/yyyy
Chargeable?
Yes
No
City  
State:  
Type of Accident  
Personal Injury
Yes
No
Fatalities
Yes
No
Additional Information:  
Convictions Involving the Use of Motor Vehicle:
Have you ever been convicted of, or forfeited bond or collateral for any of he following offenses committed after December 31, 1970?
A felony involving the use of a motor vehicle?
Yes
No
A crime involving the manufacturing, knowing transportation, knowing possession, sale or habitual use of amphetamines, a narcotic drug, a formulation of an amphetamine, or a narcotic drug?
Yes
No
Operation of a motor vehicle under the influence of alcohol, an amphetamine, a narcotic drug, a formulation of an amphetamine, or a derivative of a narcotic drug?
under the influence of alcohol, an amphetamine, a narcotic drug
Yes
No
Leaving the scene of an accident if the accident resulted in personal injury or death?
Yes
No
Any other motor vehicle law violations, INCLUDE ALL CARELESS RECKLESS DRIVING VIOLATIONS
ALL CARELESS RECKLESS DRIVING VIOLATIONS
Yes
No
Have you ever had any license to operate a motor vehicle denied, revoked, or suspended
operate a motor vehicle denied, revoked, or suspended
Yes
No
If the answer to any of the above is YES, explain below in detail, give dates, etc.  
ALCOHOL & DRUG TEST STATEMENT:
Do you use narcotics, amphetamines, or other controlled substances?
Yes
No
As per section 40.25(j) have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, a safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules.
tested positive, or refused to test, on any pre-employment drug or alcohol test
Yes
No
If you answered yes, can you provide/obtain proof that you hav successfully completed the DOT return-to-duty requirements?
provide/obtain proof that you’ve successfully completed the DOT
Yes
No
Driving / Equipment Experience:
Class of Equipment  
Type of Equipment Van/Tank/Flat, Etc.  
Date From   mm/dd/yyyy
Date To   mm/dd/yyyy
Approximate number of miles  
Tractor & Semi Trailer  
Other  
MOTOR VEHICLE DRIVER CERTIFICATION: I certify that the above is a true and complete list of all traffic violations (other than parking violations) for which I have been convicted, as well as accidents, criminal convictions, etc. I further understand that failure to list such items will be considered a false application.
Agree
Disagree
EXPERIENCE & QUALIFICATIONS
Employment History: Start with the most recent position & include all employers for he LAST TEN YEARS. List ALL gaps in employment including unemployed periods. DO NOT WRITE SEE ATTACHED RESUME. DO NOT WRITE PERSONAL AS A REASON FOR LEAVING A PRIOR EMPLOYER. COMPLETE ALL INFORMATION BELOW
Employers Name  
Supervisor  
Phone  
Address  
City  
State:  
Zip Code:  
Position  
Employed From   mm/dd/yyyy
Employed To   mm/dd/yyyy
Reason for leaving  
Ending Salary  
If a driving position, list all vehicles you operated:  
Were you subject to the FMCSRs (DOT Regulations)?
Were you subject to the FMCSRs (DOT Regulations)?
Yes
No
Was your job designated as a Safety Sensitive function subject to 49 CFR Part 40 Drug and Alcohol Testing
Subject to 49 CFR Part 40 Drug and Alcohol Te
Yes
No
Employers Name  
Supervisor  
Phone  
Address  
City  
State:  
Zip Code:  
Position  
Employed From   mm/dd/yyyy
Employed To   mm/dd/yyyy
Reason for leaving  
Ending Salary  
If a driving position, list all vehicles you operated:  
Were you subject to the FMCSRs (DOT Regulations)?
Were you subject to the FMCSRs (DOT Regulations)?
Yes
No
Was your job designated as a Safety Sensitive function subject to 49 CFR Part 40 Drug and Alcohol Testing
Subject to 49 CFR Part 40 Drug and Alcohol Te
Yes
No
Employers Name  
Supervisor  
Phone  
Address  
City  
State:  
Zip Code:  
Position  
Employed From   mm/dd/yyyy
Employed To   mm/dd/yyyy
Reason for leaving  
Ending Salary  
If a driving position, list all vehicles you operated:  
Were you subject to the FMCSRs (DOT Regulations)?
Were you subject to the FMCSRs (DOT Regulations)?
Yes
No
Was your job designated as a Safety Sensitive function subject to 49 CFR Part 40 Drug and Alcohol Testing
Subject to 49 CFR Part 40 Drug and Alcohol Te
Yes
No
Additional Information:  
Verification Release
I hereby authorize, without liability, any person or organization, including but not limited to any educational institution, training facility or any institution, whose name I have given as a reference, or by whom I have been previously employed, to furnish Metropolitan Trucking, Inc.(company) any information they may have concerning my character, habits, ability, financial responsibility, job performance, reasons for leaving employment and all information concerning my employment or training to give such information to other companies and carriers requesting such information. Furthermore, there may be entities the Company does business with that may request investigative reports or consumer reports which apply to my background. In this case, these reports would apply to my assignments to projects related to the Customer, permission to be on the Customer’s premises and to handle its products and other security concerns of the customer. I hereby release all such persons and organizations from any claims for damages of any kind, which may occur to me by reasons of furnishing such information. I hereby authorize any law enforcement agency or court or record to furnish Metropolitan Trucking, Inc. information concerning my motor vehicle record, or any felony or misdemeanor of which I have been convicted.
Under the authority granted me by 49 CFR Parts 40 and 382, I hereby authorize and require my previous and/or current employers specifically listed as well as any other person or company provided by me in writing or by verbal interview by whom I was employed or to whom I applied for employment in the two year period preceding the date of this application to release the date, type of test and result of all drug and alcohol tests taken by me, including the date and type of test for any refusals by me to take a drug or alcohol test, to the Director of Driver Personnel, or the Employment Placement Specialist assigned to process my application at Metropolitan Trucking, Inc. If I tested positive on any controlled substance test, had an alcohol test with a concentration of 0.04 or greater, or refused to take any drug or alcohol test,. I also authorize the release of all information concerning my refusal to a Substance Abuse Professional (SAP) including all records pertaining to my evaluation and treatment (if required by SAP). I authorize this release by whatever means is most expedient and agree to hold harmless any past employer or any person or company I applied with as well as their employees, agents, or representatives from all liability or damage that may arise from the release of the information specifically authorized here.
*Verification
Agree
Disagree
Verification


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