P O BOX 206 Pantego, NC 27860 (252) 943-3379 Toll Free (800) 682-2477 Get In Touch info@shavendertrucking.com Complete Online Job Application HERE: Employment Application Position Applied For * Name * First Last Social Security Number * Current Address * Address Address Line 1 Address Line 2 City 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Previous Address (If less than 3 years) Address Line 1 Address Line 2 City 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Previous Address Address Line 1 Address Line 2 City 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Do you have the legal right to work in the United States? * Yes No Date Of Birth * Have you ever worked for this company before? * Yes No If So Where? Dates: From - To Rate of Pay Can you provide proof of age? Reason For Leaving Are you currently Employed? Yes No If not, how long since your last employment? Who Referred You? Rate of pay expected Have you ever been bonded? Name Of Bonding Company Is there any reason you might be unable to perform functions of the job for which you have applied {as described in the attached job description} Name of Previous Empolyer Address Address Line 1 Address Line 2 City 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Contact Person and Phone Number Position Held Date / Time From When To When Rate Of Pay Where you subject to the FMCSR's while employed? Yes No Was your job designated as a safety-sensitive function in any DOT-Regulated Mode Subject to the drug and alcohol testing requirements of 49 CFR Part 40? Yes No Reason For Leaving Name of Previous Employer Address Address Line 1 Address Line 2 City 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Contact Person and Phone Number Position Held Date / Time From When To When Rate Of Pay Where you subject to the FMCSR's while employed? Yes No Was your job designated as a safety-sensitive function in any DOT-Regulated Mode Subject to the drug and alcohol testing requirements of 49 CFR Part 40? Yes No Reason For Leaving Name of Previous Employer Address Address Line 1 Address Line 2 City 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Contact Person and Phone Number Position Held Date / Time From When To When Rate Of Pay Where you subject to the FMCSR's while employed? Yes No Was your job designated as a safety-sensitive function in any DOT-Regulated Mode Subject to the drug and alcohol testing requirements of 49 CFR Part 40? Yes No Reason For Leaving Last Accident Date / Nature of Accident / Fatalities / Injuries / Hazardous Material Spill Next Previous Date / Nature of Accident / Fatalities / Injuries / Hazardous Material Spill Next Previous Date / Nature of Accident / Fatalities / Injuries / Hazardous Material Spill Driver's Licenses Held in the Past 3 Years State / License Number / Class / Endorsements / Expiration Date Driver's Licenses Held in the Past 3 Years State / License Number / Class / Endorsements / Expiration Date Driver's Licenses Held in the Past 3 Years State / License Number / Class / Endorsements / Expiration Date Driving Experience - Straight Truck Yes No Tractor and Semi-Trailer Yes No Tractor - Two Trailers Yes No Tractor - Three Trailers Yes No Motorcoach - School Bus Yes No More Than 8 Passengers Motorcoach - School Bus Yes No More Than 15 Passengers Other Driving Experience Check All that Apply Van Tank Flat Dump Refer Date / Time From - To Each Approximate Miles List States Operated In for the last 5 years Tell Us about any trucking, transportation or other experience that may help in your work for this company. List Courses and Training other than shown elsewhere in this application List Special Equipment or Technical materials you can work with (other than already shown) Highest Grade Completed Last School Attended How Many Years of High School Completed 1 2 3 4 How Many Years of College 1 2 3 4 Signature Clear Signature Submit MVR Report Authorization Full Name (As It Appears on Your License) * First Last License Number & State * Date of Birth Social Security Signature Clear Signature Submit HOME ABOUT US OUR MISSION EMPLOYMENT CONTACT US Shavender Trucking, LLC | P O BOX 206 Pantego, NC 27860 | (252) 943-3379 | Toll Free (800) 682-2447