CKS - Job Application

CKS Hydro Services, Inc. P.O. Box 916 Ocean Springs, MS 39566 228/872-2446 Fax 228/875-4747

Position Applying For
Today's Date / MM / DD YYYY
Name * First Last
Email Address *
Date of Birth * / MM / DD YYYY
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone * - (###) - ### ####
Alternate Phone - (###) - ### ####
Social Security Number *
Do you currently hold a commercial license? Yes No
List the issuing State, number, and expiration date of each unexpired commercial motor vehicle license or permit that has been issued to the applicant.
Briefly describe your specialized training and experience in the operation of motor vehicles, including equipment you have operated.
List all motor vehicle accidents in which the applicant was involved in during the last three (3) years preceding the date of this application. Give date and nature of each accident and any fatalities or personal injuries.
List all violations of motor vehicle laws or ordinances (other than violations than violations involving only parking) of which the applicant was convicted or forfeited bond or collateral during the three (3) years preceding the date of the application is submitted:
Write a brief statement with details, facts and circumstances of any denial, revocation, or suspension of any license, permit, or privilege to operate a motor vehicle that has been issued to the applicant, or a statement that no such denial, revocation, or suspension has occurred:
PREVIOUS EMPLOYMENT
Employer #1
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Start Date / MM / DD YYYY
End Date / MM / DD YYYY
Reason for Leaving
Employer #2
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Start Date / MM / DD YYYY
End Date / MM / DD YYYY
Reason for Leaving
Employer #3
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Start Date / MM / DD YYYY
End Date / MM / DD YYYY
Reason for Leaving
Can we contact the above employers? If no please explain:
If after October 29, 2004, were you subject to FMCSRs while employed by any of the previous employer? Yes No
Was this job designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40? Yes No
For those drivers applying to operate a commercial motor vehicle as defined by Part 383 of this subchapter, a list of the names and addresses of the applicant’s employers during the 7 year period preceding the 3 years contained in the above application for which the applicant was an operator of a commercial motor vehicle, together with the dates of employment and the reasons for leaving such employment.
This application was completed by me, and that all entries on it and information to be true and complete to the best of my knowledge. * Yes No
NOTICE TO PROSPECTIVE APPLICANTS:
A motor carrier may require an applicant to provide information in addition to the information required by paragraph (b) of this section on the application form. Before an application is submitted, the motor carrier must inform the applicant that the information he/she provides in accordance with paragraph (b)(10) of this section may be used, and the applicant's previous employers will be contacted, for the purpose of investigating the applicant's safety performance history information as required by paragraphs (d) and (e) of §391.23. The prospective employer must also notify the driver in writing of his/her due process rights as specified in §391.23(i) regarding information received as a result of these investigations. [35 FR 6460, Apr. 22, 1970, as amended at 35 FR 17420, Nov. 13, 1970; 52 FR 20589, June 1, 1987; 60 FR 38744, July 28, 1995; 69 FR 16684 March 30, 2004] CKS Hydro Services, Inc. is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment regardless of race, color, religion, gender, national origin, age, disability, veteran status or any other status protected by law.
Note: All prospective employees are subject to pre-employment medical examination, background checks, drug screening as a condition of employment.

CKS - Job Application

CKS - Job Application

PREVIOUS EMPLOYMENT

NOTICE TO PROSPECTIVE APPLICANTS:

Note: All prospective employees are subject to pre-employment medical examination, background checks, drug screening as a condition of employment.