The mission of KSI is to create opportunities for individuals with disabilities
to learn and grow. Through training, education and supportive programs and services, we
enable individuals to accomplish their personal and work-related goals.
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Driver Employment Application
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Application Information
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Position Applied For
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First Name
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Last Name
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Address
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City
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State/Province
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Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
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Postal Code
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Phone
Email Address
Desired Salary
Are you a citizen of the United States?
Yes
No
If no, are you authorized to work in the U.S?
Yes
No
Do you know anyone who works for this company?
Yes
No
If yes, who?
If yes, when?
Have you ever worked for this company?
Yes
No
How did you hear about this position?
Do you have a Delaware drivers license?
Yes
No
DL # -
State
Education
High School
Full Address
From - To
Did you graduate?
Yes
No
Diploma
College
Full Address
From - To
Did you graduate?
Yes
No
Degree
References
Please list three professional or personal references.
Full Name
Relationship
Company
Phone Number
Full Address
Full Name
Relationship
Company
Phone Number
Full Address
Full Name
Relationship
Company
Phone Number
Full Address
Previous Employment
Company
Phone
Full Address
Supervisor
Job Title
Responsibilities
From - To
Reason For Leaving
Did you drive a CDL required vehicle?
Yes
No
May we contact your previous supervisor for a reference?
Yes
No
Company
Phone
Full Address
Supervisor
Job Title
Responsibilities
From - To
Reason For Leaving
Did you drive a CDL required vehicle?
Yes
No
May we contact your previous supervisor for a reference?
Yes
No
Military Service
Branch
From - To
Rank At Discharge
Type of Discharge
Signature
Accident Record for Past 3 Years or More
Last Accident Date
Nature of Accident
Fatalities?
Yes
No
Injuries?
Yes
No
Previous Accident #2 Date
Nature of Accident
Fatalities?
Yes
No
Injuries?
Yes
No
Previous Accident #3 Date
Nature of Accident
Fatalities?
Yes
No
Injuries?
Yes
No
Traffic Convictions and Forfeitures for the Past 3 Years (Other than parking violations)
Date
Location
Charge
Penalty
Location
Date
Charge
Penalty
Location
Date
Charge
Penalty
Driver Licenses
State
License Number
Type
Expiration Date
State
License Number
Type
Expiration Date
State
License Number
Type
Expiration Date
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Yes
No
Has any license, permit or privilege ever been suspended or revoked?
Yes
No
If the answer to either question is Yes, please give details
Driving Experience
Straight Truck
Tractor & Semi-Trailer
Tractor-Two Trailers
Motorcoach-School Bus
Other
Approximate Number of Miles Total
List States Operated in for Past 5 Years
Describe any special training that will help you as a Driver
Which safe driving awards to do you hold, and from whom?
List any trucking or other experience that may help you in your work for KSI
List any courses and training other than already shown elsewhere in this application
List special equipment or technical materials you can work with (other than listed elsewhere)
Disclaimer and Signature
I expressly authorize, without reservation, Kent-Sussex Industries, Inc. herein after known as “the employer”, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, addendum(s), resume or job interview. I hereby waive any and all rights and claims may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's CEO. I certify that all information that I have provided in order to apply for and secure work with this employer is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to eliminate me from further consideration for employment, or may result in my immediate termination from the employer’s service, whenever it is discovered.
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Signature
Upload Resume
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Kent Sussex Industries, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age (40 or older), disability, genetic information, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. KSI is committed to providing reasonable accommodations to individuals with disabilities throughout the application and employment process. If you need an accommodation, please contact us.
Voluntary Self-Identification of Disability Form CC-305 OMB Control Number 1250-0005
Why Am I being asked for fill out this form? This employer is a federal contractor or subcontractor required by law to reach out to, hire, and provide equal opportunity to qualified people with disabilities. We must make reasonable efforts to have at least 7% of our workforce be individuals with disabilities. To help us measure how well we are doing, we invite you to tell us if you have a disability or if you ever had a disability. Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. If you are applying for a job, any answer you give will be kept private and separate from the selection process. It will be maintained in a confidential file and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way. Because a person may become disabled at any time, we must ask all of our employees to update their information at least every five years. If you already work for us, your answer will not negatively impact you in any way, regardless of whether you have self-identified in the past. Again, the information you provide will be maintained in a separate, confidential file. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp. How do you know if you have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: • Autism • Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS • Blind or low vision • Cancer • Cardiovascular or heart disease • Cerebral palsy • Deaf or hard of hearing benefiting from hearing aid(s) • Depression or anxiety • Diabetes • Epilepsy • Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome, celiac disease • Intellectual disability • Missing limbs or partially missing limbs • Nervous system condition for example, migraine headaches, Parkinson’s disease, or Multiple sclerosis (MS) • Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression
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Please check one of the boxes below:
YES, I HAVE A DISABILITY, OR HAVE A HISTORY/RECORD OF HAVING A DISABILITY
NO, I DO NOT HAVE A DISABILITY
I PREFER NOT TO ANSWER
VOLUNTARY INVITATION TO SELF-IDENTIFY
Qualified applicants are considered for employment without regard to race, religion, sex, national origin, age, marital status, sexual orientation, veteran status, disability, or other protected characteristic. This employer is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, we invite qualified applicants to voluntarily self-identify their race or ethnicity, gender, and veteran status (if applicable). Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information you submit will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.
Gender
Male
Female
Please select only one of the choices below:
Hispanic or Latino
White (not Hispanic or Latino)
American Indian or Alaskan Native (not Hispanic or Latino)
Black or African American (not Hispanic or Latino)
Native Hawaiian or Other Pacific Islander (not Hispanic or Latino)
Asian (not Hispanic or Latino)
Two or more races (not Hispanic or Latino)
Decline Self-Identification
SPECIAL NOTICE TO PROTECTED VETERANS:
Regulations issued by the U.S. Department of Labor with respect to Vietnam Era veterans and other protected veterans require that federal contractors provide an opportunity for self-identification to candidates seeking employment. Such self-identification is submitted on a voluntary and confidential basis for use only in accordance with regulations, and without subjecting the individual to adverse treatment. If you believe you belong to any of the categories of protected veterans, listed on the 2nd page of this form, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.
Select One
I identify as one or more of the classifications of protected veterans
I am not a protected veteran
Submit
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