Employment Application

START A CAREER AT KINETIC INDUSTRY

Application for Employment

We are excited that you are interested in working at Kinetic Industry. To be considered for a position, please fill out our online application form below. If you have any questions, please email our HR Department at hr@kineticindustry.com

What position are you applying for?(Required)

Name(Required)

First Last

Phone

Date of Birth

Residency

Please provide previous 3 years of residency.

Current Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Previous Address 1

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Previous Address 2

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Previous Address 3

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

License Information

Section 383.21 FMCSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver’s license". I certify that I do not have more than one motor vehicle license, the information for which is listed below.

State(Required)

License Number(Required)

License Type(Required)

License Expiration(Required)

Endorsements

Passenger

School bus/Passenger Combo

Doubles/Triples

Endorsements

Tanker

Hazmat

Tanker/Hazmat Combo

Driving Experience

STRAIGHT TRUCK

Type of Equipment

Date From

Date To

Approx. Total Miles

TRACTOR AND SEMI-TRAILER

Type of Equipment

Date From

Date To

Approx. Total Miles

TRACTOR - TWO TRAILERS

Type of Equipment

Date From

Date To

Approx. Total Miles

Your Accident Record for the Past 2 Years or More

Accident Check

Check here if no accidents within the past 3 years

ACCIDENT 1

Date

Nature of Accident

Number of Fatalities

Number of Injuries

Chemical Spills

Yes

ACCIDENT 2

Date

Nature of Accident

Number of Fatalities

Number of Injuries

Chemical Spills

Yes

ACCIDENT 3

Date

Nature of Accident

Number of Fatalities

Number of Injuries

Chemical Spills

Yes

Your Traffic Convictions and Forfeitures for the Past 3 Years

Accident Check

If no convictions and forfeitures within the past 3 years please check here

TRAFFIC CONVICTIONS AND FORFEITURES 1

Date Convicted

Violation

State of Violation Location

Penalty

TRAFFIC CONVICTIONS AND FORFEITURES 2

Date Convicted

Violation

State of Violation Location

Penalty

TRAFFIC CONVICTIONS AND FORFEITURES 3

Date Convicted

Violation

State of Violation Location

Penalty

License Revocation/Denial Information

Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Yes

Has any license, permit or privilege ever been suspended or revoked?

Yes

Employment Record

Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years. You must give the same information for all employers you have driven a commercial motor vehicle for the seven years prior to the initial three years (total of ten years employment record).

PREVIOUS/CURRENT EMPLOYER

Name of Employer

Address

Phone Number

Position Held

Employed From

Employed To

Select today's date if still employed

Salary

Reason for Leaving

Any gaps in employment and/or unemployment must be explained. Include dates (Month/Year) and reason.

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer?

Yes

Was the previous job position 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?

Yes

Check here to add a second previous employer

Name of Employer

Address

Phone Number

Position Held

Employed From

Employed To

Final Salary

Reason for Leaving

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer?

Yes

Was the previous job position 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?

Yes

Check here to add a third previous employer

Name of Employer

Address

Phone Number

Position Held

Employed From

Employed To

Final Salary

Reason for Leaving

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer?

Yes

Was the previous job position 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?

Yes

ATTACHMENTS

Upload a cover letter and resume

File

Drop files here or

Max. file size: 2 GB.

To be Read and Signed by Applicant

I authorize you to make sure investigations and inquiries to my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

Review information provided by current/previous employers;
Have errors in the information corrected by previous employers and for those previous employers to re-send thecorrected information to the prospective employer; and
Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannotagree on the accuracy of the information.

PLEASE CHECK THE BOX TO VERIFY YOU AGREE(Required)

I Agree

NOTE: A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations.

Employment Application

START A CAREER AT KINETIC INDUSTRY

Application for Employment

Residency

License Information

Driving Experience

STRAIGHT TRUCK

TRACTOR AND SEMI-TRAILER

TRACTOR - TWO TRAILERS

Your Accident Record for the Past 2 Years or More

ACCIDENT 1

ACCIDENT 2

ACCIDENT 3

Your Traffic Convictions and Forfeitures for the Past 3 Years

TRAFFIC CONVICTIONS AND FORFEITURES 1

TRAFFIC CONVICTIONS AND FORFEITURES 2

TRAFFIC CONVICTIONS AND FORFEITURES 3

License Revocation/Denial Information

Employment Record

PREVIOUS/CURRENT EMPLOYER

ATTACHMENTS

To be Read and Signed by Applicant

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