Bestway Transport, Inc.

1260 N. Ellis St. Bensenville, IL 60106
Ph: 630‐616‐1600 Fx: 630‐616‐1900 E‐mail: dispatch@gobestway.com

Application for Employment

Signature of Applicant

Date

First Name

Middle Name

Last Name

Phone

*Current Address

Street Address 1

Street Address 2

City

State

Zip Code

*If at the above residence less than three years, list below all residences for the past years. Attach a separate sheet if necessary.

Street Address 1

Street Address 2

City

State

Zip Code

Street Address 1

Street Address 2

City

State

Zip Code

Position applying for

Temporary

Part Time

Full Time

Who referred you?

Rate of pay expected?

Have you worked for this company before ?

Date: From

Date: to

Where ?

Rate of Pay

Position

Reason for leaving

Name of any relatives employed by this company

Are you currently employed?

If not, how long since leaving last employment?

Education

Last school attended - Name

Address

General

Have you ever been bonded?

Name of bonding company

Have you ever been convicted of a felony?

If yes, please explain fully on a separate sheet of paper. Conviction of a crime is not an automatic bar to employment ‐ all circumstances will be considered.

Have you ever worked for this company under another name ?

If so, under what name ?

Driver Experience & Qualification

Answer the question in this section only if applying for driver position

Date of Birth

The U.S. Department of Transportation requires that driver applicants state their date of birth(391.27)

Social Security No.

DRIVER EXPERIENCE & QUALIFICATION(Answer the question if applying for drivong position) Licenses

Drivers Licenses State Class held in past 3 years must be shown

State

License No

Class

Endorsement(s)

Expiration Date

State

License No

Class

Endorsement(s)

Expiration Date

State

License No

Class

Endorsement(s)

Expiration Date

State

License No

Class

Endorsement(s)

Expiration Date

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No

B. Has any license, permit or privilege ever been suspended or revoked? Yes No

C. Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations? Yes No

If you answered "yes" to A, B, C, attach a statement giving details.

Driving Experience

Class of Equipment

Type of Equipment (Van, Tank, Flat, Etc.)

Dates: From to

Total Miles

Class of Equipment

Type of Equipment (Van, Tank, Flat, Etc.)

Dates: From to

Total Miles

Class of Equipment

Type of Equipment (Van, Tank, Flat, Etc.)

Dates: From to

Total Miles

Class of Equipment

Type of Equipment (Van, Tank, Flat, Etc.)

Dates: From to

Total Miles

List states operated in during last five years

List special courses or training that will help you as a driver

List driving award held and who awards were presented by ?

Accident Review for past 3 years(Attach separate sheet of paper if more space is needed)

Dates(Last Accident)

Nature of accident (Head‐On, Rear‐End, Overturn, etc.)

Fatalities

Injuries

Next Previous

Nature of accident (Head‐On, Rear‐End, Overturn, etc.)

Fatalities

Injuries

Next Previous

Nature of accident (Head‐On, Rear‐End, Overturn, etc.)

Fatalities

Injuries

Traffic Convictions and Forfeitures for the past 3 years other than parking violations

Location

Dates

Charge

Penalty

Location

Dates

Charge

Penalty

Employment Record

The U.S. Department of Transportation requires that driver applications show all employment for the past three years. Those applying for a position requiring a CDL, must show employment history for 10 years prior to date of this application. &392.21(B)(10), (11)

Start with most recent or current position, including military experience, and work backwards

Current Employer:

Supervisor's Full Name:

Full Address:

Zip:

Phone:

Position Held:

From:

To:

Salary:

Reason for leaving

Previous Employer:

Supervisor's Full Name:

Full Address:

Zip:

Phone:

Position Held:

From:

To:

Salary:

Reason for leaving

Past Employer:

Supervisor's Full Name:

Full Address:

Zip:

Phone:

Position Held:

From:

To:

Salary:

Reason for leaving

APPLICANT MUST READ AND SIGN

I certify that I have read and understood all of this employment application. It is agreed and understood that the employer or his agents may investigate my background to ascertain and and all information of concern to my employment history, whether same is of record or not, and I release employers and other person named herein from all liability for any damages on account of funishing such information. I understand that as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a physical examination and drug test.

I further certify that I am a genuine applicant for employment and this application is being sumitted solely for the purpose of seeking employment with the employer and for no other reason.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91‐508, I have been told that this investingation may include an investigative Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal.

If hired, I agree to abide by all the rules and policies of the employer. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

Date:

Applicant Signature