Johnson Feed Inc. Employment Application

Contact Information

Full Name:
Address:
City:
State: Zip:
Home Phone:    
Cell Phone:    
Email: Best time to call:
SSN:
Date of Birth    
CDL Information
CDL Number:
Issue State: Expiration Date:
Check all that apply to your current CDL:
Class A Class B Class C Hazmat
Tanker Double
Position Desired
One field must be chosen
Company Driver Owner Operator Regional Company Driver    
Total OTR years:
 
Trailer Type Experience
TRAILER TYPE EXPERIENCE  
Flatbed  
Van  
Tanker  
Reefer  
Hazmat  
Car Hauler  
Household Goods  
Specialized  
Double/Triple  
Driving Experience By Region  
Check all that apply:
North West Midwest North East
South West     South East
 
Current Employer
Employer name :
Address Phone
City State Zip
Start date
 
 
 
Previous Employer#1
Employer name :
Address Phone
City State Zip
Start date
End date
 
Previous Employer#2
Employer name :
Address Phone
City State Zip
Start date
End date
 
Previous Employer#3
Employer name :
Address Phone
City State Zip
Start date
End date
 
Accidents
Number of accidents (last 3 years)
 
Tickets
Number of tickets received (last 3 years)
Have you ever received a ticket for reckless driving? Yes   No
Have you ever been convicted of a felony? or misdemeanor? Yes   No
Have you ever been convicted, or are any charges pending, for driving while under the influence of alcohol, a narcotic drug, amphetamines or derivatives thereof? Yes   No
Has any license, permit or privilege ever been suspended or revoked? Yes   No
Have you ever tested positive on a drug screen? Yes   No
 

By typing my name I am signing this application. I    , hereby attest that the information provided is true and accurate.

By typing my name I   , authorize Johnson Feed, Inc. to investigate the information that I have provided and request Driver Information Records from (USIS) DAC Services. This may include but not limited to the following information: names and dates of previous employers, reason for termination of employment, work experience, accidents, drug & alcohol testing etc.

Authorize