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Boyd and Sons, Inc.
Company: 

Boyd and Sons, Inc.

R.R. #3 Box 226

Washington, IN 47501

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, marital status, veteran status, non-job related disability, or any other protected group status.

TO BE READ AND SIGNED BY APPLICANT

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand, also, that I am required to abide by all rules and regulations of the Company.

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand I have the right to:
  • Review information provided by previous employers;
  • Have errors in information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
  • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.
Electronic Signature
Date / /
Position(s) Applied for
Applicant Name
Date of Application / /
FIRST NAME MI LAST NAME

M / DAY / YEAR
Phone ( ) -
E-Mail
Social Security No. - -
Driver License No.
Current Address
How Long?

STREET

 yr./ mo.

CITY

STATE

 ZIP CODE
Previous Addresses

Previous 1
How Long?

STREET

 yr./ mo.

CITY

STATE

 ZIP CODE

Previous 2
How Long?

STREET

 yr./ mo.

CITY

STATE

 ZIP CODE

Previous 3
How Long?

STREET

 yr./ mo.

CITY

STATE

 ZIP CODE
Do you have the legal right to work in the United States? 
Date of Birth  / /
Can you provide proof of age? 
   (Required for Commercial Drivers)
Have you worked for this company before? 
Where? 
Dates: From  / /   To   / /
Rate of Pay 
Position 
Reason for leaving 
Are you now employed? 
If not, how long since leaving last employment?   months
Who referred you? 
Rate of pay expected 
Have you ever been bonded? 
Name of bonding company  
   (Answer only if a job requirement)
Have you ever been convicted of a felony? 
If yes, please explain fully on a separate sheet of paper and fax to 812-254-2035. Conviction of a crime is not an automatic bar to employment - all circumstances will be considered. 
Is there any reason you might be unable to perform the functions of the job for which you have applied?
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. If another sheet is necessary fax to  812-254-2035.)

EMPLOYER

DATE
NAME 
ADDRESS 
CITY 
STATE
ZIP CODE 
CONTACT PERSON 
PHONE NUMBER  ( ) -
REASON FOR LEAVING 
FROM
MO. YR.
TO
MO. YR.
POSITION HELD

SALARY WAGE

WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?  

WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40? 

EMPLOYER

DATE
NAME 
ADDRESS 
CITY 
STATE
ZIP CODE 
CONTACT PERSON 
PHONE NUMBER  ( ) -
REASON FOR LEAVING 
FROM
MO. YR.
TO
MO. YR.
POSITION HELD

SALARY WAGE

WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?  

WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40? 

EMPLOYER

DATE
NAME 
ADDRESS 
CITY 
STATE
ZIP CODE 
CONTACT PERSON 
PHONE NUMBER  ( ) -
REASON FOR LEAVING 
FROM
MO. YR.
TO
MO. YR.
POSITION HELD

SALARY WAGE

WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?  

WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40? 

EMPLOYER

DATE
NAME 
ADDRESS 
CITY 
STATE
ZIP CODE 
CONTACT PERSON 
PHONE NUMBER  ( ) -
REASON FOR LEAVING 
FROM
MO. YR.
TO
MO. YR.
POSITION HELD

SALARY WAGE

WERE YOU SUBJECT TO THE FMCSRs WHILE EMPLOYED?  

WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40? 

EMPLOYER

DATE
NAME 
ADDRESS 
CITY 
STATE