Application For Employment
LeFleur Transportation is an Equal Opportunity Employer.
(This application is only valid for the position(s) listed and is void after 30 days.)
Application must be complete.
Last Name
First Name
Middle Name
Address
City
County
State
Zip
Time at this address
- Click to select - ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGIN ISLANDS VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING
Less than 3 months 3 to Six Months 6 to 12 Months 1 To 2 Years 2 To 3 Years 3 To 4 Years 5 To 6 Years 6 or more years
Mailing Address if Different
Home Phone
Cell Phone
Email:
Social Security Number
Driver License Number / State
/ - Click to select - ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGIN ISLANDS VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING
County / State - Desired
Date Available
Working Hours/Days
Have you previously been associated with LeFleur Transportation? Yes No If yes, when and where?
Do you have any relatives currently associated with us? Yes No If yes, please give the name(s).
Please list all addresses at which you have lived within the past 10 years.
Are you presently authorized to work in the U.S. on a full-time basis? Yes No
Have you ever been convicted of, pled guilty to, or paid a fine for any criminal offense? Yes No (a conviction will not necessarily disqualify an applicant). If yes, please explain.
Do you have a commercial driver’s license? Yes No What class?
Date of Birth (persons applying for driving positions only)
If you are applying for a driving position, will you provide LeFleur Transportation with a current motor vehicle record (must be dated within 30 days of application date)? Yes No If no, please explain.
Do you have driving experience? Yes No If yes, please list and describe the types of vehicles have you driven?
In order to be considered for a driving position, LeFleur Transportation may run a criminal background check. Are you willing to release this information to us? Yes No (your signature authorizes release of this information)
Do you know of any reason(s) that might make it difficult for the LeFleur Transportation to obtain surety bond insuring your honesty? Yes No If yes, please explain.
How were you referred to LeFleur Transportation?
Please note the total number of days absent from school or work this past year.
Have you ever been known by or used any other name? Yes No If yes, please list the other social security and drivers license numbers.
Please provide the name, address and phone number of three (3) references who are not related to you and are not previous employers.
1.
2.
3.
Education
High School
School Name
Address, City, St, Zip
Did you graduate?
Yes No
Degree received
Course of study
Overall grade point average
List any specialized Training or apprenticeships
List any honors received
Undergraduate
Graduate
Other
Are you planning further studies? Yes No If yes, where and when?
Types of Courses:
Would you be a Part Time Full Time student?
Describe job-related skills (i.e. computer software capabilities, typing (wpm), accounting, data entry, collections, etc.)
List your current and ALL prior employers for previous 5 years Start with your present or last job, including any military service, part-time or volunteer activities. Use a separate sheet if necessary to complete any of this information. A resume will not be considered.
Current or Most Recent Employer:
Phone
Employed
Part Time Full Time Other
From To
Start Final Pay
City / State
Duties
Job Title
Supervisor
Reason for Leaving
Have you been disciplined, counseled, warned, asked to resign or discharged at this organization? Yes No If yes, explain.
Employer No 1:
Employer No 2:
Employer No 3:
Employer No 4:
Have you ever been disciplined, counseled or discharged by any employer? Yes No . If yes, explain
From
To
Please list and explain any periods of time of four weeks or more that you were not working
4.
List and explain in detail giving dates and location of all accidents that you have been involved in during the past 5 years. In any type of vehicle, and regardless of whether you feel they were chargeable or nonchargeable. FAILURE TO LIST ALL ACCIDENTS MAY RESULT IN YOUR DISQUALIFICATION.
IF YOU HAVE NO ACCIDENTS IN THE PAST 5 YEARS, TYPE "NONE" IN THIS BOX AND MOVE TO THE NEXT SECTION.
Date
Type Vehicle
Whose Fault
Fatalities?
$ Amount of All Damage
Select Answer Other Vehicle Self 3rd Party
Select Answer Yes No
Details
I certify the following is a true and complete list of traffic violations (other than parking violations) for which I have been convicted of forfeited bond or collateral during the past 5 years. FAILURE TO LIST ALL TRAFFIC VIOLATIONS MAY RESULT IN YOUR DISQUALIFICATION.
IF YOU HAVE NO TRAFFIC VIOLATIONS IN THE PAST 5 YEARS, TYPE "NONE" IN THIS BOX AND MOVE TO THE NEXT SECTION.
Traffic Conviction(s): Describe
City & State
Penalty
PLEASE READ CAREFULLY
I certify that the information which I have provided in this application is true and complete to the best of my knowledge and that I have withheld no information or other response that, would, if disclosed, affect this application unfavorably. I understand that any misleading or incorrect statements or responses may render this application void and may result in the immediate cancellation of my agreement regardless of the point in time at which the misleading or incorrect statement or response was discovered.
I understand that LeFleur Transportation may conduct an investigation concerning my character, general reputation, mode of living, employment history, job performance, criminal records, motor vehicle records and credit history. I authorize LeFleur Transportation to obtain, and any person, corporation, or governmental unit whom LeFleur Transportation contacts to release to LeFleur Transportation all information known to them regarding my character, general reputation, mode of living, employment history, job performance, criminal records, motor vehicle records, credit history, and other qualifications, whether or not it is in their records. I hereby release both LeFleur Transportation and any and all persons, corporations, governmental units, and law enforcement agencies contacted by LeFleur Transportation from any and all liability for any damage flowing from the disclosure of this information and LeFleur Transportation’s action thereon.
I agree to submit myself, whenever requested by LeFleur Transportation to a physical examination by medical personnel designated by LeFleur Transportation and to testing for the presence of alcohol and other drugs or substances by medical personnel designated by LeFleur Transportation. I understand and agree that any positive test result, or the refusal to submit to such testing, may result in disciplinary action up to, and including, termination. LeFleur Transportation is a drug free workplace.
I acknowledge that LeFleur Transportation reserves the right to inspect all property (including vehicles, purses, lockers, desks, lunch boxes, packages, and other containers) on LeFleur Transportation’s premises and I agree to allow and to cooperate with such inspections. I also agree that LeFleur Transportation has permission to photograph me and to utilize the photographs in furtherance of LeFleur Transportation’s business. I understand that LeFleur Transportation and its employees will, from time to time, monitor my performance and activities under the agreement while I am working or while I am on LeFleur Transportation property, by electronic, video and/or voice transmittal and receiving equipment and telephonic monitoring devices. LeFleur Transportation has my permission to engage in such monitoring and I fully release and hold harmless LeFleur Transportation, its officers, employees and agents of any claim or complaint and damages whatsoever that I may have against them relating to, directly or indirectly, to this monitoring activity.
I further acknowledge and understand that LeFleur Transportation has the unilateral right, at any time and for any reason, to terminate my employment with or without notice. I further understand and agree my employment is not for any specific term or period of time, and that LeFleur Transportation may terminate my employment with or without cause, with or without notice, and without further obligation to me, at the sole and absolute discretion and will of LeFleur Transportation. I understand that no representative of LeFleur Transportation, other than the Chief Executive Officer, has any authority to enter into any agreement for any specified period of time, or to make any agreement contrary to the foregoing, and then only by a written individual employment agreement, signed by the CEO.
I understand the Company’s receipt of this application does not entitle me to an agreement to become an employee. This application will be considered only for position for which I apply and will become void and no longer considered thirty (30) calendar days from the date of this application.
My signature below certifies that the application for employment presented to you was completed by me and all entries are true and complete to the best of my knowledge. I also agree that falsified information and significant omissions may result in my disqualification now or any time. I understand that my qualification can be terminated, with or without cause, at any time at the discretion of the company or myself. I authorize all persons and/or institutions to provide relevant information, including my alcohol and controlled substance testing and accident history that may be required to complete my qualification and I agree to release them from any land all liability for supplying this information. I understand this is not a contract and does not alter the at-will status of my employment with LeFleur Transportation. This should not be considered a promise of guarantee of consideration for employment with LeFleur Transportation.
By submitting this application electronically, I certify that I personally completed this application and that all of the information is true and correct. I hereby request and authorize LeFleur Transportation to cause to be conducted, at any time, an investigation of my background for qualification purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, mode of living, 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. In connection with my application for employment, I understand that consumer reports which may contain public record information may be requested from DAC Services. I understand that the completion of this form does not assure me of a position with any company or obligate any company in any way. I have completed this application of my own free will and hold Total LeFleur Transportation harmless of all liability for providing this application for my use.
Electronic Signature: By typing your name and date into the text boxes; you are signing this application. You agree to its terms and conditions of your signature thereto may be implied.
Date: Applicant Signature:
