BFL, Inc. 1883 South State Road 161 Rockport, IN 47635 Office (812) 649-9103
Social Security#:
Address: City:
State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code: Phone:
Do you have the legal right to work in the United States?
Date of Birth? (required for Commercial Drivers)
Can you provide proof of age? Yes No
Dates (From): To:
Rate of Pay: Position:
Reason For Leaving?
Are you now employed? Yes No
If not, how long since leaving last employment?
Who referred you? Rate of pay expected?
If yes, explain if you wish:
Select Highest Grade Completed: Grammar School: 1 2 3 4 5 6 7 8 High School: 1 2 3 4 College: 1 2 3 4
Name of last school attended: City:
A.) Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No B.) Has any license, permit or privilage ever been suspended or revoked? Yes No
If the answer to either A or B is YES, please explain why below:
DRIVING EXPERIENCE : CLICK HERE IF NONE
List States operated in for last five years:
Show special courses or training that will help you as a driver:
Which safe driving awards do you hold and from whom?
Show any trucking, transportation or other experience that may help in your work for this company:
List courses and training other than shown elsewhere in this application:
List special equipment or technical materials you can work with (other than those already shown)
Date Employed : Point Employed :
Department: Classification: (If rejected, summary report of reasons should be placed in file).
Dismissed: Voluntarily Quit: Other:
Street: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: Telephone: Fax: to release and forward the information requested by section 3 of this document concerning my Alcohol and Controlled Substances Testing records within the previous 3 years from