Warren C. Sauers Co., Inc. - Employment Application

Employment Application

This form has several pages. As you work your way through the form, when you reach the bottom of each page you'll find a button that advances you to the next page and a button that allows you to return to the previous page. You can move back and forth in the form as much as necessary in order to enter complete information before submitting the form (the last button on the last page). As you fill out the form and advance to each new page, be sure that you start filling out the form at the top of each page (you may have to scroll up to start at the top).

Page 1: Employment Application
In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job-related disability, or any other protected group status. Items marked with a (*) are required.
Application Date: *
Position Applied For: *	Company Driver Owner Operator
Applicant Name (First, Middle, Last): *
Social Security No.: *
Current Address (Street, City, State, Zip): *
Phone: *
E-mail address:
Previous Address 1 (Street, City, State, Zip):
Previous Address 2 (Street, City, State, Zip):
Previous Address 3 (Street, City, State, Zip):
Date of Birth: *
Who referred you?
Rate of Pay Expected?
Have you worked for Sauers before? *	Yes No
If Yes, Date From:
If Yes, Date to:
Are you now employed? *	Yes No
If not, how long since leaving last employment?
If not, reason for leaving last employment:
Have you ever been convicted of a felony? *	Yes No
If yes, please explain:

Warren C. Sauers Co., Inc. 2601 Rochester Rd. Cranberry Twp., PA 16066

Page 2: Employment History
All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 10 years. List complete mailing address, street number, city, state, and zip code. NOTE: List employers in reverse order, starting with the most recent. Please fill out a complete set of information for each of the employers for whom you have worked in the past 10 years. When you're finished, scroll to the bottom of this page and continue to the next page of the application.
Employer 1 Name of Company: *
Employer 1 Address (Street, City, State, Zip): *
Employer 1 Dates (Date started, date ended): *
Employer 1 Position held: *
Employer 1 Reason for leaving: *
Employer 1 Contact (Name and Phone #): *
Employer 1 Were you subject to the FMSCRs while employed? *	Yes No
Employer 1 Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? *	Yes No
If you need to provide information for another employer, keep going. If you are finished, scroll to the bottom of this page and click Continue to the Next Page.
Employer 2 Name of Company:
Employer 2 Address (Street, City, State, Zip):
Employer 2 Dates (Date started, date ended):
Employer 2 Position held:
Employer 2 Reason for leaving:
Employer 2 Contact (Name and Phone #):
Employer 2 Were you subject to the FMSCRs while employed?	Yes No
Employer 2 Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?	Yes No
If you need to provide information for another employer, keep going. If you are finished, scroll to the bottom of this page and click Continue to the Next Page.
Employer 3 Name of Company:
Employer 3 Address (Street, City, State, Zip):
Employer 3 Dates (Date started, date ended):
Employer 3 Position held:
Employer 3 Reason for leaving:
Employer 3 Contact (Name and Phone #):
Employer 3 Were you subject to the FMSCRs while employed?	Yes No
Employer 3 Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?	Yes No
If you need to provide information for another employer, keep going. If you are finished, scroll to the bottom of this page and click Continue to the Next Page.
Employer 4 Name of Company:
Employer 4 Address (Street, City, State, Zip):
Employer 4 Dates (Date started, date ended):
Employer 4 Position held:
Employer 4 Reason for leaving:
Employer 4 Contact (Name and Phone #):
Employer 4 Were you subject to the FMSCRs while employed?	Yes No
Employer 4 Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?	Yes No
If you need to provide information for another employer, keep going. If you are finished, scroll to the bottom of this page and click Continue to the Next Page.
Employer 5 Name of Company:
Employer 5 Address (Street, City, State, Zip):
Employer 5 Dates (Date started, date ended):
Employer 5 Position held:
Employer 5 Reason for leaving:
Employer 5 Contact (Name and Phone #):
Employer 5 Were you subject to the FMSCRs while employed?	Yes No
Employer 5 Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?	Yes No
If you need to list more than 5 employers over the past 10 years, Please provide the following information here for each employer: Company name, Contact name, and Contact phone number. When finished, continue to the Next Page.

Warren C. Sauers Co., Inc. 2601 Rochester Rd. Cranberry Twp., PA 16066

Page 3: Additional Applicant Information
On this page, please provide COMPLETE information about your accident record, traffic convictions, licenses held within the preceding 3 years, and your driving experience.
ACCIDENT RECORD: FOR EVERY ACCIDENT FOR THE PAST 3 YEARS, REGARDLESS OF FAULT, please list 1) accident date, 2) nature of accident, 3) # of fatalities, and 4) # of injuries.
TRAFFIC CONVICTIONS: Please list all traffic convictions and forfeitures for the past three years. For each, indicate 1) Location; 2) Date; 3) Charge; and 4) Penalty.
LICENSES: Please list all Driver Licenses held in the past three years. For each license, indicate 1) State; 2) License Number; 3) Type; 4) Expiration Date.
Have you ever been denied a license, permit or privilege to operate a motor vehicle?	Yes No
Has any license, permit or privilege ever been suspended or revoked?	Yes No
If you answered Yes to either of the two preceding questions, please give a complete explanation here:
DRIVING EXPERIENCE: STRAIGHT TRUCK. Indicate 1) Type of equipment; 2) Dates; 3) Approx. no. of miles. If no experience, enter None.
DRIVING EXPERIENCE: TRACTOR AND SEMI TRAILER. Indicate 1) Type of equipment; 2) Dates; 3) Approx. no. of miles. If no experience, enter None.
DRIVING EXPERIENCE: TRACTOR - TWO TRAILERS. Indicate 1) Type of equipment; 2) Dates; 3) Approx. no. of miles. If no experience, enter None.
DRIVING EXPERIENCE: MOTOR COACH - SCHOOL BUS. Indicate 1) Type of equipment; 2) Dates; 3) Approx. no. of miles. If no experience, enter None.
DRIVING EXPERIENCE: OTHER. Indicate 1) Type of equipment; 2) Dates; 3) Approx. no. of miles. If no experience, enter None.
List states in which you have operated for the last 5 years:
Which SAFE DRIVING AWARDS do you hold and from whom?
If you have any comments, questions, or suggestions, please enter them here:

Warren C. Sauers Co., Inc. 2601 Rochester Rd. Cranberry Twp., PA 16066

Last update: 25 June 2007