Online Employment Application & Printable Application

Barber Trucking, Inc.
3661 Rt. 28 North
Brookville, PA 15825
Phone: 800-326-9870     814-328-5333
Fax: 814-328-5337

Date (MM/DD/YYYY) :

Personal Biography
Barber Trucking Inc. is an equal opportunity employer. Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, handicap, or veteran status.

Position(s) Applying For (Please check ALL that apply) :
Flat Bed   Van   Dispatch   Garage   Full-Time   Part-Time   Other

All applications must be completed by the applicant only. No other person my complete any part of this application.

Name       Social Security Number (Ex: 123-45-6789)
Address Line 1       Phone (Ex: 123-456-7890)
Address Line 2
City       State       ZIP Code
Previous Address

Age (Driving Position Only)
Birthdate (Driving Position Only) (MM/DD/YYYY) :
Physical Exam Expiration Date (Driving Position Only) (MM/DD/YYYY) :

Are you a citizen of the United States? Yes    No
Are you eligible to work in the United States? Yes    No

Emergency Contact       Phone (Ex: 123-46-7890)
Address       Relationship

Have you ever been discharged or suspended from any job?   No   Yes

If "Yes", please explain.


Education

Select highest level completed:
High School 7   8   9   10   11   12   College 1   2   3   4  

Please list all schools and training related to trucking in which you have participated:


Employment

All time must be accounted for. This includes military service, self-employment, unemployment, etc. (If additional space is needed, please call us at 800-326-9870 or e-mail us at trucking@barbertrucking.com )

Are you presently employed?  Yes    No
If "Yes," may we contact your current employer?  Yes    No

Please fill out the information below, beginning with your current or most recent employer.

Company name :    Phone :
Address :    Supervisor :
Position Held :    From    To
What were your job duties?

Reason for leaving:


Company name :    Phone :
Address :    Supervisor :
Position Held :    From    To
What were your job duties?

Reason for leaving:


Company name :    Phone :
Address :    Supervisor :
Position Held :    From    To
What were your job duties?

Reason for leaving:


Company name :    Phone :
Address :    Supervisor :
Position Held :    From    To
What were your job duties?

Reason for leaving:


Company name :    Phone :
Address :    Supervisor :
Position Held :    From    To
What were your job duties?

Reason for leaving:


Accident Record for Past 3 Years (if additional space is needed, please contact us at the number listed above)
Date of Accident     Nature of Accident
Location of Accident     Number of Injured     Number of Fatalities

Date of Accident     Nature of Accident
Location of Accident     Number of Injured     Number of Fatalities

Date of Accident     Nature of Accident
Location of Accident     Number of Injured     Number of Fatalities

Traffic Violations for Past 3 Years (if additional space is needed, please contact us at the number listed above)
Date     Location
Charge     Penalty

Date     Location
Charge     Penalty

Date     Location
Charge     Penalty

Driver's License(s)
Please list all driver's licenses held within the past 3 years. If additional space is needed, please contact us at the number listed above.
State     License #     Type
Endorsements     Expiration Date

State     License #     Type
Endorsements     Expiration Date

State     License #     Type
Endorsements     Expiration Date

Driving Experience
Straight Truck  To   From   Approx. Miles Driven
Tractor & Semi-Trailer  To   From   Approx. Miles Driven
Tractor & Two Trailers  To   From   Approx. Miles Driven

Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Yes   No
If "Yes," please explain.


Has any license, permit, or privilege ever been suspended or revoked? Yes   No
If "Yes," please explain.


Have you ever been convicted of a misdemeanor or felony? Yes   No
If "Yes," please explain.


Have you ever been convicted of a DUI or DWI? Yes   No
If "Yes," please explain.


To be Read and Signed by Applicant

It is agreed and understood that any misrepresentation given on this personal biography shall be considered an act of dishonesty.

I give Barber Trucking, Inc. and its agents or representatives the right to investigate all references and to secure additional information about my personal background. I hereby release from all liability for damages Barber Trucking, Inc. and its agents or representatives for seeking such information and all other persons, corporations, or organizations for furnishing such information.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

It is agreed and understood that this personal biography in no way obligates Barber Trucking, Inc. to employ me.

It is agreed and understood that if hired, I may be on a probationary period, during which I may be disqualified without recourse.

This certifies that this personal biography was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

It is agreed that by submitting the above information with my name and the date entered below, I understand that I am electronically signing this document and this will be regarded as though I am signing an actual physical document for Barber Trucking Inc.

Name of Applicant     Date

In consideration of your application, the Department of Transportation requires an investigation of your employment background. As part of this investigation, consumer reports about you may be obtained from USIS Services. USIS is a consumer reporting agency. USIS does not make any decisions concerning your employment. You have the right to obtain a free copy of the consumer report from USIS and the right to dispute the accuracy or completeness of your report. Your consent to obtain the report from USIS is required. Although you have a right to withhold your consent, this may be considered when reviewing your application.

If you give your permission to obtain consumer reports, please check the box below. If the box is left unchecked, it will be regarded as a denial of consent.

I have read the release and I give my permission to obtain consumer reports about me.