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Company

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Personal Information

Incomplete information may disqualify you from further consideration.

Name*

First Last

Email*

Phone*

Today's Date*

Address*

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

Do you possess an active Driver's License*

Yes

No

Do you currently have a commercial driver's license or CDL permit?*

Yes

No

Is it a license or permit?*

License

Permit

Is the license Class A or B?*

Class A

Class B

Work Eligibility

Are you eligible to work in the U.S?*

Yes

No

Are you at least 18 years or older?*

Yes

No

You must be at least 18 years of age to be eligible for employment.

Can you work any shift?*

Yes

No

Can you work overtime, including weekends?*

Yes

No

Are you able to travel out of town, overnight, for extended periods of time?*

Yes

No

Have you ever been terminated from employment or asked to resign by an employer?*

Yes

No

If yes, please provide company names and details.*

Do you have any felony convictions?*

Yes

No

If yes, please explain and include approximate date(s):*

We run background checks and honesty counts. Circumstances of convictions can be considered if listed here.

References

Give the names of three professional references, not related to you, whom you have known and/or worked with previously.

Please provide a minimum of three (3) personal references.

Display Reference Forms*

Reference One

Reference Two

Reference Three

Select which reference forms are need below, at least one is required.

Reference One

Incomplete information could disqualify you from further consideration.

Name*

First Last

Company Name

Email

Years Acquainted*

Please enter a number from 0 to 99.

Describe relationship.

Phone*

Address

Street Address Address Line 2 City State ZIP Code

Reference Two

Incomplete information could disqualify you from further consideration.

Name*

First Last

Company Name

Years Acquainted*

Please enter a number from 0 to 99.

Describe relationship.

Phone*

Email

Address

Street Address Address Line 2 City State ZIP Code

Reference Three

Incomplete information could disqualify you from further consideration.

Name*

First Last

Company Name

Years Acquainted*

Please enter a number from 0 to 99.

Describe relationship.

Phone*

Email

Address

Street Address Address Line 2 City State ZIP Code

Resume

Max. file size: 1 GB.

(Optional)

Submit

Review the terms of the Application Policy and submit for application.

The application will be valid for 90 days after the date submitted.

I have read and agree to the Application Policy*

I agree

I hereby authorize Central Seal Company -- hereafter referred to as "Central Seal" -- to investigate my past employment, education, criminal background history, credit history, driving record, medical history, worker's compensation history, military service, and other matters as may be necessary in arriving at decision relating to my employment. Further, I release my previous employers, personal references and all other responders to Central Seal inquiries from liabilities of damages on account having furnished information about me in good faith and in accordance with applicable laws.

I understand that current and/or previous employers will be contacted for the purpose of investigating my records. In particular, I authorize Central Seal to seek information concerning my criminal background history, my driving history, my safety performance history, and my participation in and results of employer drug and alcohol testing (including refusals) in accordance with Federal Motor Carrier Safety Regulations (FMCSR). Accordingly, I acknowledge my consent with special regard to government law enforcement agencies, related third party report services, and other persons or organizations holding such information about me to share these records with Central Seal, releasing them from any liability for their contributions. I acknowledge my right: 1)to review information provided by previous employers; 2) to have errors in the information corrected by previous employers and for those previous employers to resend the corrected information to the prospective employer; and 3) to have a rebuttal statement attached to the alleged erroneous information if the previous employer(s) and I cannot agree on the accuracy of the information. Should I become a Central Seal employee, I acknowledge the requirement of periodic inquiries into my FMCSR related records during and after my period of employment. Accordingly, I extend my consent and release of liability for damages regarding persons or organizations involved in sharing my FMCSR records during and beyond my period of employment. A FAX or a scanned or photographic copy of this authorization shall be as valid as the original.

I acknowledge that Central Seal seeks to hire, without discrimination, only lawful workers. I hereby confirm my eligibility for legal employment within the U.S., and I understand that my identification and my eligibility for legal employment within the U.S. will be verified by the U.S. Department of Homeland Security and the Social Security Administration.

I understand that I am entitled to a statement of my rights under the Fair Credit Reporting Act. I understand that information regarding sex, race and date of birth is requested in compliance with federal and state laws and will not be used to discriminate against me.

I certify the accuracy and completeness of all information I provide in this application and during my subsequent interview(s). I understand that providing false or misleading information may result in rejection of my application or a termination of my employment and associated benefits in the event that I am employed with Central Seal. Finally, I understand that I am required to abide by all of Central Seal' rules and regulations. THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE SUBMITTED.

Signature*

Name Date

Additional Information

is there anything else that you would like to share that may help us better understand your qualifications or interest in the position?

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Central Seal Employment Application

Personal Information

Work Eligibility

Job Details

Referral Source

Education

Military Service

Employment History

Current or Previous Employer

Previous Employer Two

Previous Employer Three

Accident Review for the Past 3 Years

DOT-Regulated Drug & Alcohol Testing History — Applicant Disclosure & Consent

Previous Employment with DOT-Regulated Employers (Previous 3 Years)

References

Reference One

Reference Two

Reference Three

Submit