Vernon Milling Company :: Vernon, Alabama

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DRIVER APPLICATION for EMPLOYMENT

Click here to download application.

* REQUIRED FIELDS
Personal Information
* Full Name:
* Address:
* City:
* State:
* Zip:
Email:
* Home Phone:
Alternative Phone:
* Date of Birth:
* SSN:		- -
Previous Addresses
1.	Address:
	City:
	State:
	Zip:
2.	Address:
	City:
	State:
	Zip:
3.	Address:
	City:
	State:
	Zip:

* Do you have the right to work in the U.S.?		YES NO
* Have you worked for this company before?		YES NO
If yes, where?
Dates:
Rate of pay:
Position:
Reason for leaving:
* Are you currently employed?		YES NO
If no, how long since your last employment?
Who referred you?
Rate of pay expected:

* Is there any reason you might be unable to perform the functions of the job for which you have applied? YES NO
If yes, explain if you wish:

Employment History All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state, and zip code. Applicants to drive a commercial motor vehicle in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent.)
1.	Company Name:
	Address:
	City:
	State:
	Zip Code:
	Contact Person:
	Phone:
	Position Held:
	Salary/Wage:
	From Date (month/year):
	To Date (month/year):
	Reason For Leaving:
2.	Company Name:
	Address:
	City:
	State:
	Zip Code:
	Contact Person:
	Phone:
	Position Held:
	Salary/Wage:
	From Date (month/year):
	To Date (month/year):
	Reason For Leaving:
3.	Company Name:
	Address:
	City:
	State:
	Zip Code:
	Contact Person:
	Phone:
	Position Held:
	Salary/Wage:
	From Date (month/year):
	To Date (month/year):
	Reason For Leaving:
4.	Company Name:
	Address:
	City:
	State:
	Zip Code:
	Contact Person:
	Phone:
	Position Held:
	Salary/Wage:
	From Date (month/year):
	To Date (month/year):
	Reason For Leaving:
5.	Company Name:
	Address:
	City:
	State:
	Zip Code:
	Contact Person:
	Phone:
	Position Held:
	Salary/Wage:
	From Date (month/year):
	To Date (month/year):
	Reason For Leaving:
6.	Company Name:
	Address:
	City:
	State:
	Zip Code:
	Contact Person:
	Phone:
	Position Held:
	Salary/Wage:
	From Date (month/year):
	To Date (month/year):
	Reason For Leaving:
7.	Company Name:
	Address:
	City:
	State:
	Zip Code:
	Contact Person:
	Phone:
	Position Held:
	Salary/Wage:
	From Date (month/year):
	To Date (month/year):
	Reason For Leaving:
8.	Company Name:
	Address:
	City:
	State:
	Zip Code:
	Contact Person:
	Phone:
	Position Held:
	Salary/Wage:
	From Date (month/year):
	To Date (month/year):
	Reason For Leaving:
9.	Company Name:
	Address:
	City:
	State:
	Zip Code:
	Contact Person:
	Phone:
	Position Held:
	Salary/Wage:
	From Date (month/year):
	To Date (month/year):
	Reason For Leaving:
10.	Company Name:
	Address:
	City:
	State:
	Zip Code:
	Contact Person:
	Phone:
	Position Held:
	Salary/Wage:
	From Date (month/year):
	To Date (month/year):
	Reason For Leaving:

Accident Record for Past 3 Years (If none, check box )
1.	Date of Last Accident:
	Nature of Accident:
	Fatalities:	YES NO #:
	Injuries:	YES NO #:
2.	Date of Next Previous Accident:
	Nature of Accident:
	Fatalities:	YES NO #:
	Injuries:	YES NO #:
3.	Date of Next Previous Accident:
	Nature of Accident:
	Fatalities:	YES NO #:
	Injuries:	YES NO #:
Traffic Convictions and Forfeitures for Past 3 Years - other than parking violations (If none, check box )
1.	Location:
	Date:
	Charge:
	Penalty:
2.	Location:
	Date:
	Charge:
	Penalty:
3.	Location:
	Date:
	Charge:
	Penalty:

Education
* Highest Grade Completed:
Last School Attended:
City/State:

Experience and Qualifications
* 1.	State Driver License:
	License Number:
	Type:
	Expiration:
2.	State Driver License:
	License Number:
	Type:
	Expiration:
3.	State Driver License:
	License Number:
	Type:
	Expiration:

* Have you been denied a license, permit, or privilege to operate a motor vehicle? YES NO * Has any license, permit, or privilege ever been suspended or revoked? YES NO If yes to either question, please explain: List any criminal convictions in the last 10 years:
Driving Experience
Straight Truck		If none, check box
Type of Equipment (van, flat, etc.):
Dates (from/to):
Total No. of Miles:
Tractor and Semi-Trailer		If none, check box
Type of Equipment (van, flat, etc.):
Dates (from/to):
Total No. of Miles:
Tractor-Two Trailers		If none, check box
Type of Equipment (van, flat, etc.):
Dates (from/to):
Total No. of Miles:
Motorcoach/School Bus		If none, check box
Type of Equipment (van, flat, etc.):
Dates (from/to):
Total No. of Miles:
Other
Type of Equipment (van, flat, etc.):
Dates (from/to):
Total No. of Miles:

List states operated in for last five years. List special courses or training that will help you as a driver. List Safe Driving awards you hold and from whom. List any trucking, transportation, or other experience that may help in your work for this company. List courses and training other than already listed. List special equipment or technical materials you can work with other than already listed.

Please click the "Submit Application" button only once and allow time for the form to process. This may take a moment.

VERNON MILLING COMPANY
Vernon, AL 35592
800-753-1993 (toll free) | 205-695-7192 (fax)