Job Application - Northstar Environmental Services

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Location Applying for:(Required)

Date of Application(Required)

Position(s) Applied for(Required)

Your Name(Required)

First Middle Last

Phone(Required)

TWIC Holder(Required)

Yes

Current Address(Required)

How Long?

Previous Address(Required)

How Long?

Add Previous Address 1

Add Previous Address

Previous Address

How Long?

Add Previous Address 2

Add Previous Address

Previous Address

How Long?

Have you ever worked for Northstar or any of its subsidiaries before?(Required)

Yes

If so, please check which company:(Required)

Boat World

River Services

Other

Position(Required)

Position

From

Reason for Leaving

Are You Currently Employed?(Required)

Yes

If not, how long have you been unemployed(Required)

Are you legally eligible for employment in this country?(Required)

Yes

Are you under age 18?(Required)

Yes

Accident History

Have you been party to an accident in the last 3 years?(Required)

Yes

Date of Accident(Required)

Nature of Accident(Required)

Any Fatalities or Injuries?(Required)

Yes

Fatalities(Required)

Please enter a number from 0 to 10000.

Injuries(Required)

Please enter a number from 0 to 10000.

Haz Mat Spill(Required)

Yes

Add More Accidents 1

Add More Accidents

Date of Accident(Required)

Nature of Accident(Required)

Any Fatalities or Injuries?(Required)

Yes

Fatalities(Required)

Please enter a number from 0 to 10000.

Injuries(Required)

Please enter a number from 0 to 10000.

Haz Mat Spill(Required)

Yes

Add More Accidents 2

Add More Accidents

Date of Accident(Required)

Nature of Accident(Required)

Any Fatalities or Injuries?(Required)

Yes

Fatalities(Required)

Please enter a number from 0 to 10000.

Injuries(Required)

Please enter a number from 0 to 10000.

Haz Mat Spill(Required)

Yes

Traffic Violation History

Have you had any traffic convictions or forfeitures in the last 3 years? (exclude parking violations)(Required)

Yes

Date of Conviction(Required)

Violation Type(Required)

State of Violation(Required)

Penalty(Required)

Add Traffic Convictions 1

Add Traffic Convictions

Date of Conviction(Required)

Violation Type(Required)

State of Violation(Required)

Penalty(Required)

Add Traffic Convictions 2

Add Traffic Convictions

Date of Conviction(Required)

Violation Type(Required)

State of Violation(Required)

Penalty(Required)

Untitled

License Information

Section 383.21 FMCSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license". I certify that i do not have more than one motor vehicle license, the information for which is listed below.

State(Required)

License Information(Required)

Expiration Date(Required)

Date of Birth(Required)

Have you ever been denied a license, permit or privilege to operate a motor vehicle?(Required)

Yes

Has any license, permit or privilege ever been suspended or revoked?(Required)

Yes

If you answered yes, give details:(Required)

Driving Experience

Class of Vehicle

Straight Truck

Circle Type

Van

Tank

Dump

Reefer

Dates

From

Approximate Miles

Class of Vehicle 2

Tractor/Semi Trailer

Circle Type

Van

Tank

Dump

Reefer

Dates

From

Approximate Miles

Class of Vehicle 3

Tractor-2 Trailers

Circle Type

Van

Tank

Dump

Reefer

Dates

From

Approximate Miles

Class of Vehicle 3

Motor Coach/Bus

Circle Type

8+ Passengers

15+ Passengers

Dates

From

Approximate Miles

List states operated in for the last 5 years

List special courses, training or safety awards

List any trucking, transportation or other experience that may help you in obtaining work with this comapny

Employment History

All applicants wishing to drive interstate commerce must provide the following information on all employers during the preceding three years. You must give the same information for all employers for whom you have driven a commercial vehicle seven years prior to the initial 3 years (total of 10 year employment record). You are required to list the complete mailing address: street number and name, city, state and zip code. Print & List most recent employer first.

Employer Name(Required)

Phone(Required)

Address(Required)
Street Address City State / Province / Region ZIP / Postal Code

Position Held(Required)

Dates(Required)
From
To

Reason For Leaving(Required)

Were you subject to the Federal Motor Carrier Regs while employed?(Required)

Yes

No

Was your job designated a safety sensitive function in any DOT regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?(Required)

Yes

No

Account for period between jobs - include dates and reason.(Required)

Add Employment History 1
Add Employment History

Employer Name(Required)

Phone(Required)

Address(Required)
Street Address City State / Province / Region ZIP / Postal Code

Position Held(Required)

Dates(Required)
From
To

Reason For Leaving(Required)

Were you subject to the Federal Motor Carrier Regs while employed?(Required)

Yes

No

Was your job designated a safety sensitive function in any DOT regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?(Required)

Yes

No

Account for period between jobs - include dates and reason.(Required)

Add Employment History 2
Add Employment History

Employer Name(Required)

Phone(Required)

Address(Required)
Street Address City State / Province / Region ZIP / Postal Code

Position Held(Required)

Dates(Required)
From
To

Reason For Leaving(Required)

Were you subject to the Federal Motor Carrier Regs while employed?(Required)

Yes

No

Was your job designated a safety sensitive function in any DOT regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?(Required)

Yes

No

Account for period between jobs - include dates and reason.(Required)

Add Employment History 3
Add Employment History

Employer Name(Required)

Phone(Required)

Address(Required)
Street Address City State / Province / Region ZIP / Postal Code

Position Held(Required)

Dates(Required)
From
To

Reason For Leaving(Required)

Were you subject to the Federal Motor Carrier Regs while employed?(Required)

Yes

No

Was your job designated a safety sensitive function in any DOT regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?(Required)

Yes

No

Account for period between jobs - include dates and reason.(Required)

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Accident History

Traffic Violation History

License Information

Driving Experience

Employment History

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