Phoenix Area Dispatch
Flagstaff Area Dispatch
Office
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info@azmatl.com

Non Dot Application For Employment

Name in full

Present Address

Address for Past 3 years

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Who do we notify in case of emergency during working hours?

All Driver Licenses Held Last 3 Years

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Education

High School
College or University
Business or Technical
Other
The ability to be bonded is a condition for hire. A photograph and copy of your fingerprints may be required after employment.

References (Personal) Other Than Relatives

Previous Employment

(Give a complete record of all employment and reason for periods unemployed during the past 10 years. Start with your most recent employment)
(ATTACH SHEET IF MORE SPACE IS NEEDED)
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* (10) (iv) (A) Applicant was subject to the Federal Motor Carrier Safety Regulations while employed by that previous employer.
** (10)(iv)(B)Job was designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40.

Driving Experience Record

Straight Truck
Tractor and Semi-Trailer
Tractor Two Trailers
Other

Accident Record For Past 3 Years

(ATTACH SHEET IF MORE SPACE IS NEEDED)
Last Accident
Next Previous
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Traffic Convictions and Forfeitures for Past 3 Years (other than parking violations)

(ATTACH SHEET IF MORE SPACE IS NEEDED)
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If the answer to either A or B is YES, attach statement giving details.

General Driving Record

(ATTACH SHEET IF MORE SPACE IS NEEDED)
To date, I have driven trucks for years, covering approx. miles.
The date of my last accident while driving a commercial vehicle was since that time, I have driven approx. accident free miles.

Safe Driving Awards, etc.

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Applicant: Read and Sign Before Submitting This Application

I authorize the employer or his agents to investigate my background to ascertain any and all information of concern to my record, whether same is of record or not, and release employers and persons named herein from all liability for any damages on account of his furnishing such information.

I understand that misrepresentation or omission of facts called for on this employment application will, if hired, result in discharge. Labor Code Section 2922 states that employment, having no specified term, may be terminated at the will at either party. The employer adheres to this section of the Labor Code and hereby puts the applicant on notice that all employment offered by the employer may be terminated at the will of either party without cause.

This certifies that this application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge.