{field:equal_opportunity_agreement_1678115437266}

Signature:{field:signature_1667851898253}

Date:{field:date_1667871114249}

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Date Of Birth:{field:date_of_birth_1667852186746}

Date:{field:date_1667852175104}

Signature:{field:signature_1667852160951}

{field:employment_application_1678115478616}

First Name:{field:first_name_1667852653394}

Last Name:{field:last_name_1667852617632}

Address:{field:street_address_1667852645896}

Address Line 2:{field:address_line_2_1667852661904}

City:{field:city_1667852676272}

State:{field:state_province_region_1667852687743}

Zip:{field:postal_zip_code_1667852706401}

Country:{field:country_region_1667852722428}

Email:{field:email_address_1667852756092}

Phone:{field:phone_1667852739834}

{field:education_and_training_1678116100869}

Grade/Highschool:{field:grade_highschool_1667852892952}

College:{field:college_1667854272145}

High School Name:{field:high_school_name_1667854322461}

Start Date:{field:start_date_1667854342775}

End Date:{field:end_date_1667854350997}

College Name:{field:college_name_1667854360085}

Start Date:{field:start_date_1667854369471}

End Date:{field:end_date_1667854378805}

Are you a United States Citizen, or an alien lawfully authorized to work in the United States?:{field:are_you_a_united_states_citizen_or_an_alien_lawfully_authorized_to_work_in_the_united_states_1667854396231}

Are you a Union Member?{field:are_you_a_union_member_1667854441936}

If Yes: Local #:{field:if_yes_local_1667854456835}

Type of Work Applying For:{field:type_of_work_applying_for_1667854466416}

Equipment Operated?:{field:equipment_operated_1667854476578}

Equipment Specialty?:{field:equipment_specialty_1667854505607}

Years of Experience:{field:years_of_experience_1667854520167}

Have you worked for Myles Lorentz Inc. before?:{field:have_you_worked_for_myles_lorentz_inc_before_1667854537445}

If yes, when?:{field:if_yes_when_1667854549985}

Do you have a valid driver's license?:{field:do_you_have_a_valid_driver_s_license_1667854595906}

Drivers License State & Number:{field:drivers_license_state_and_number_1676766228178}

Do you have a CDL?:{field:do_you_have_a_cdl_1667854605926}

CDL Expiration Date:{field:cdl_expiration_date_1676766605432}

Do you have an MSHA certificate?:{field:do_you_have_an_msha_certificate_1667854640711}

{field:driving_operating_experience_1678116115211}

Straight Truck:{field:straight_truck_1667855101405}

From:{field:from_1667854913166}

To:{field:to_1667854922001}

Tractor and Semi-Trailer:{field:tractor_and_semi-trailer_1667855093117}

From:{field:from_1667854957838}

To:{field:to_1667854965676}

Heavy Equipment:{field:heavy_equipment_1667855079753}

From:{field:from_1667855012773}

To:{field:to_1667855019788}

Equipment Maintenance:{field:equipment_maintenance_1667855059954}

From:{field:from_1667855137598}

To:{field:to_1667855149339}

{field:maintenance_experience_or_training_1678116124298}

ACCIDENT/RECORD for the past 3 years (include date, type and location):{field:accident_record_for_the_past_3_years_include_date_type_and_location_1667855254109}

Traffic Convictions & Forfeitures for the past three (3) years (other than non-moving):{field:traffic_convictions_and_forfeitures_for_the_past_three_3_years_other_than_non-moving_1667855331593}

Driver's License (List each driver's license held in the past three (3) years):{field:driver_s_license_list_each_driver_s_license_held_in_the_past_three_3_years_1667855354934}

Have you ever been denied a license, permit or privilege to operate a motor vehicle?:{field:have_you_ever_been_denied_a_license_permit_or_privilege_to_operate_a_motor_vehicle_1667855421734}

Has any license, permit or privilege ever been suspended or revoked?:{field:has_any_license_permit_or_privilege_ever_been_suspended_or_revoked_1667855434842}

Is there any reason you might be unable to perform the functions of the job for which you have applied (as described by the job description)?:{field:is_there_any_reason_you_might_be_unable_to_perform_the_functions_of_the_job_for_which_you_have_applied_as_described_by_the_job_description_1667855444856}

Have you ever been convicted of a felony involving the use of a commercial motor vehicle?:{field:have_you_ever_been_convicted_of_a_felony_involving_the_use_of_a_commercial_motor_vehicle_1667855455568}

If Yes, Please give details:{field:if_yes_please_give_details_1667855473390}

Employer 1 Name:{field:employer_1_name_1667855582173}

Address:{field:address_1667855599277}

City:{field:city_1667856235289}

State / Province / Region:{field:state_province_region_1667855615166}

Postal / Zip Code:{field:postal_zip_code_1667855623662}

Phone:{field:phone_1667855632355}

Date Started:{field:date_started_1667855646286}

Date Ended:{field:date_ended_1667856024970}

Position Title:{field:position_title_1667855677811}

Pay:{field:pay_1667855690020}

Reason for Leaving:{field:reason_for_leaving_1667855705203}

Were you subject to the FMCSRs* while employed here?:{field:were_you_subject_to_the_fmcsrs_while_employed_here_1667855751818}

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to drug and alcohol testing requirements of 49CFT Part 40?:{field:was_your_job_designated_as_a_safety-sensitive_function_in_any_dot-regulated_mode_subject_to_drug_and_alcohol_testing_requirements_of_49cft_part_40_1667855771209}

Employer 2 Name:{field:employer_2_name_1667855941471}

Address:{field:address_1667855946569}

City:{field:city_1667855954583}

State / Province / Region:{field:state_province_region_1667855957695}

Postal / Zip Code:{field:postal_zip_code_1667855961791}

Phone:{field:phone_1667855972794}

Date Started:{field:date_started_1667855969338}

Date Ended:{field:date_ended_1667856033551}

Pay:{field:pay_1667855992808}

Position Title:{field:position_title_1667855996224}

Reason for Leaving:{field:reason_for_leaving_1667855999795}

Were you subject to the FMCSRs* while employed here?:{field:were_you_subject_to_the_fmcsrs_while_employed_here_1667856003817}

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to drug and alcohol testing requirements of 49CFT Part 40?:{field:was_your_job_designated_as_a_safety-sensitive_function_in_any_dot-regulated_mode_subject_to_drug_and_alcohol_testing_requirements_of_49cft_part_40_1667856008366}

Employer 3 Name:{field:employer_3_name_1667856225576}

Address:{field:address_1667856230669}

City:{field:city_1667856235289}

State / Province / Region:{field:state_province_region_1667856240046}

Postal / Zip Code:{field:postal_zip_code_1667856244664}

Phone:{field:phone_1678128174964}

Date Started:{field:date_started_1667856253628}

Date Ended:{field:date_ended_1667856258661}

Pay:{field:pay_1667856264018}

Position Title:{field:position_title_1667856269448}

Reason for Leaving:{field:reason_for_leaving_1667856273663}

Were you subject to the FMCSRs* while employed here?:{field:were_you_subject_to_the_fmcsrs_while_employed_here_1667856280096}

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to drug and alcohol testing requirements of 49CFT Part 40?:{field:was_your_job_designated_as_a_safety-sensitive_function_in_any_dot-regulated_mode_subject_to_drug_and_alcohol_testing_requirements_of_49cft_part_40_1667856288131}

{field:equal_opportunity_employer_1678115536051}{field:drug_policy_1678115521560}{field:drug_policy_details_1678115555355}{field:drug_alcohol_details_1678115580161}

Have you ever tested positive for or refused any drug and alcohol test administered by an employer? :{field:have_you_ever_tested_positive_for_or_refused_any_drug_and_alcohol_test_administered_by_an_employer_1667856489482}

Signature :{field:signature_1667856506453}

Date:{field:date_1667856515343}

{field:terms_and_conditions_1678115618160}

{field:equal_opportunity_agreement_1678115437266}

{field:please_submit_a_copy_of_your_resume_optional_1667856586352}

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