GoBox Employment Application Step 1 of 3 33% Please enter the name of the position(s) that you are applying for consideration of employment.Your Personal InformationYour Name(Required) First Last Your Email Address Enter Email Confirm Email Your Phone(Required)When is the best time for us to reach you via telephone?(Required)MorningsEarly AfternoonLate AfternoonEarly EveningCurrent Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Have you lived at this address for three or more years?(Required) Yes, I have lived here for more than three (3) years. No, I have lived at another address within the past three (3) years. List your address(es) of residency for the past three years:If you have lived in your current address for morePrevious Address #1 Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Length of Residency for most recent previous address.How long did you live at this address?Previous Address #2 Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Length of Residency for second most recent previous address.How long did you live at this address?Previous Address #3 Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Length of Residency for third most recent previous address.How long did you live at this address? Do you have the legal right to work in the United States?(Please be prepared to provide supporting documentation if you are contacted for an interview.) Yes No Are you currently employed? Yes No May we contact your present employer? Yes No If not currently employed, how long since leaving last employment?Less than a month1-6 months1-3 yearsOver 3 yearsNever usedWho referred you to our company?Please include a phone number if available.Please select the highest grade of education completed.Did not complete High School or GEDHigh School/GEDAssociate DegreeBachelor's DegreeGraduate or Professional DegreeSome CollegeOtherName of the last school you attended.Please give the name and address of the last school that you attended as a student.What was your course of study?Example: Your college major, associates degree program name, high school diploma etc...Previous EmploymentAll driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding three years. Applicants to drive a commercial motor vehicle* in interstate or intrastate commerce shall also provide an additional seven years information on those employers for who m the applicant operated such vehicle. Print all information and complete all sections. Complete mailing addresses, street number, city, state, zip code and phone number are required. * includes vehicles having a GVWR of 10,001 pounds or more, vehicles designed to transport nine (9) or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding.Employment HistoryList employers in reverse order starting with the most recent, or current, employer.Previous Employer(s)(Required)You may add rows as needed for additional employers by clicking the "+" button on the right side of this line.Company Name:Mailing Address: City, State Zip:Position Held:Supervisor Name/Phone Number:Dates of employment:Reason for Leaving: Add Remove QualificationsDriver's License(s) - list each license held in the previous three (3) yearsYour license numbers may be required to complete your application in person or over the phone. Please be prepared to provide this information if you are contacted by our company.State of LicensureType of LicenseExpiration Date Add RemoveHave you ever been denied a license, permit, or privilege to operate a motor vehicle? Yes No If you have been denied a license, permit, or privilege to operate a motor vehicle, please briefly explain.Has any license, permit, or privilege ever been suspended or revoked? Yes No If you have had a license, permit, or privilege to operate a motor vehicle revoked please explain.List any special courses, training or awards which may pertain to the job for which you are applying:DescriptionReceived byDate Add RemoveDriver ExperienceList information regarding your driving experience for the last five years. If no driving experience, input "none".Straight TruckYears of Driving ExperienceApproximate Number of Miles Add RemoveTractor and Semi-TrailerYears of Driving ExperienceApproximate Number of Miles Add RemoveMotorcoach/BusYears of Driving ExperienceApproximate Number of Miles Add RemoveOtherPlease Describe Your "Other" ExperienceYears of Driving ExperienceApproximate Number of Miles Add RemoveTraffic Convictions and ForfeituresList all traffic convictions and forfeitures for the past three (3) years. Do not include parking violations.LocationDateChargePenalty Add RemoveAccident HistoryFederal Motor Carrier Safety Regulations require that all potential employees applying for a position to drive a motor vehicle furnish a list of all motor vehicle accidents in which the applicant was involved during the three (3) years preceding the date the application is submitted, specifying the date and nature of each accident and any fatalities or personal injuries it caused. (FMCSR, April 1, 2007 391.21 (b) (7))List all motor vehicle accidents for the past three (3) years.Date of accidentNature of accidentFatalitiesInjuries Add RemoveYour ResuméIf you have a prepared resumé, you may upload it in .pdf, .doc or .docx format here.Upload Your ResumeAccepted file types: pdf, doc, docx, Max. file size: 25 MB. Terms and Conditions(Required)This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize you to inquire of personal, employment, financial, medical and other related matters as may be necessary at arriving at employment decisions. I hereby release employers, schools, health care providers and other personnel from all liability in response to and release of information regarding my application. In the event of employment, I understand that false and/or misleading information given in my application or interview may result in discharge. I understand that I am required to abide by all rules and regulations of the company for which I am applying. I understand that information I provide regarding current and/or previous employers may be used, and those employers will be contacted, for the purpose of investigating my safety performance history as required by 49CFR391.23(d) and (e). I also understand I have the following rights: (1) Review of information provided by previous employers (2) Have errors in such information corrected and resent by previous employers to the prospective employer (3) Have a rebuttal statement attached to the alleged erroneous information if previous employer and I cannot agree on the accuracy of the information. I agree to the terms and conditions.
