Hoosier Air Transport, Inc.

Drivers Application for Employment
All fields marked with * are required.

If you would like to apply by mail, feel free to print this page and send to:

Hoosier Air Transport, Inc.
Attn: Pat Gann
P.O. Box 963
Columbus, IN 47202

(answer all questions - please print)

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

Driver Information

Name(First):*
Name(Last):*
Social Security Number:*
Address:*
City:*
State:*
Zip:*
Phone:* (xxx-xxx-xxxx)
Email Address:
Date of Birth: (mm/dd/yyyy)

Miscellaneous Information

CDL Driver's License #:
Expiration Date: (mm/dd/yyyy)
State:
Years of Experience:
Hazardous Materials Endorsement: Yes No
Have you ever been convicted of a crime? Yes No
    If yes, explain:

Was your license ever suspended/revoked? Yes No
    When? (mm/dd/yyyy)    Where?
Number of moving violations in the last 3 years:
Any accidents in the last 3 years? Yes No
    When? (mm/dd/yyyy)
    Who was at fault?
    Damage Amount:
Type of equipment operated and number of years each:
    Van:
    Tanker:
    Flatbed:
    Other:
Reference Name:
Phone Number: (xxx-xxx-xxxx)

Current Employer Information

Current Employer:
Position:
Dates of Employment:
From: (mm/dd/yyyy)
To: (mm/dd/yyyy)
Pay:
City:
State:
Phone: (xxx-xxx-xxxx)
Contact:

Past Employer (1) Information

Past Employer:
Position:
Dates of Employment:
    From: (mm/dd/yyyy)
    To: (mm/dd/yyyy)
Pay:
City:
State:
Phone: (xxx-xxx-xxxx)
Contact:
Why did you leave?

Past Employer (2) Information

Past Employer:
Position:
Dates of Employment:
    From: (mm/dd/yyyy)
    To: (mm/dd/yyyy)
Pay:
City:
State:
Phone: (xxx-xxx-xxxx)
Contact:
Why did you leave?

Past Employer (3) Information

Past Employer:
Position:
Dates of Employment:
    From: (mm/dd/yyyy)
    To: (mm/dd/yyyy)
Pay:
City:
State:
Phone: (xxx-xxx-xxxx)
Contact:
Why did you leave?

I hereby authorize Hoosier Air Transport, Inc. to conduct a thorough background investigation in accordance with state and federal law, which may include, but not limited to, criminal history, past work experience, alcohol or drug test results, or any information that may reflect upon my potential for employment. I certify that I personally completed this application and that all information is true and correct and hold them harmless of all liability from the release of said information.

Applicant's Name: Date:

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