Apply Online - Pendleton Sanitary Service

Position(s) Applying For*

Name*

First Middle Last

Phone*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How Long?*

Please Provide Addresses for the Past Three Years (if not current)

Do you have the legal right to work in the United States?*

Yes

Are you 21 years of age or over?*

Yes
No

Date of Birth*

In Case of Emergency Notify:

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Have you worked for PSSI before?*

Yes
No

List Dates Employed and Reason for Leaving*

Names of relatives in our employment (if any)

Are you now employed?*

Yes
No

How long since last employement?*

Who referred you (if any)

Rate of pay expected*

If there is any reason you might be unable to perform the functions of the job for which you are applying, please explain.

Last Employer (Name, Address, Contact, Address, Job Description, and Reason for Leaving)*

Second Employer (Name, Address, Contact, Address, Job Description, and Reason for Leaving)

Third Employer (Name, Address, Contact, Address, Job Description, and Reason for Leaving)

Fourth Employer (Name, Address, Contact, Address, Job Description, and Reason for Leaving)

Have you served in the U.S. Armed Forces?*

Yes
No

Provide Branch and Service Dates*

Select Highest Education / Grade Completed*

Are you bondable?*

Yes
No

Please Explain*

Please list License State, License Type, and License Expiration Date (License Number will be Collected Later)*

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 subject to section 391 of the Federal Motor Carrier Safety Regulations?*

Yes
No

Please provided a statement giving details about any yes answer in A, B, or C*

Driving Experience

If you have experience with any of the following, please provide the type of equipment (van, tank, flat, etc...), dates of experience, and approx. number of miles (total).

Straight Truck

Tractor and Semi-Trailer

Tractor-Two Trailers

Heavy Equipment

I agree that to my knowledge I have provided accurate and complete information.*

Yes

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