First Name *

Last Name

Address *

Phone Number (no spaces or punctuation please) *

Do you have a personal reference, or how did you hear about this position?

Social Security Number (For Insurance Purposes) *

Date of Birth ( mm/dd/yy ) *

Do you have a commercial license (class?) *

What kind of driving experience do you have? *

Do you have any traffic convictions in the past 5 years other than parking tickets? *

What hours and days would you prefer to work?

Pursuant to changes effective August 1, 2001, in Part 40 of the Federal Motor Carrier Safety Regulations, this section is being added to the driver application and should be completed by each applicant. These changes require each motor carrier to inquire of prospective drivers the information in the question below. Have you, the applicant, had a positive alcohol or drug test result or refused to take a DOT drug or alcohol pre-employment test within the past three years

• Yes
• No

What hours or days are you not available to work?

What Is your Driver's License Number? *

Applicant must read and sign. I certify that I have read and understood all of this employment application. It is agreed and understood that the employer or its agents may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or not. I hereby release The Climb, its officers, employees, agents, directors, affiliates and attorneys and any other persons named herein from all liability for any damages on account of furnishing such information. I understand that as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a physical examination and drug test. It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an Investigative Consumer Report, including information regarding my character, general reputation, personal characteristics and mode. I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. I also understand that misrepresentation of omission of information of facts may result in my rejection or dismissal. It is agreed and understood that this application for employment in no way obligates the employer to employ the applicant. If hired, I agree to abide by all the results and policies of my employer. 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. This also certifies that I have received a copy of the job description and company policies and all questions have been answered to my satisfaction. *