METRO DISPOSAL INC.

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JOB OPPORTUNITIES

Instructions: Please complete the following form and click "Submit".

DRIVER'S APPLICATION FOR EMPLOYMENT
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, veteran status, non-job related disability, or any other protected group status.

Personal Information

Address:
City:
State:
Zip:
Date of Application:
Position Applied For:
Name (Last, First, M):
Social Security No:

List your addresses of residency for the past 3 years.

Residency

Current Address Street:
Current Address City:
Current Address State:
Current Address Zip:
Current Address Phone:
Current Address Length of Residency:
Previous Address Street:
Previous Street City:
Previous Address State & Zip:
Previous Address Length of Residency:
Previous Address Street:
Previous Street City:
Previous Address State & Zip:
Previous Address Length of Residency:
Previous Address Street:
Previous Street City:
Previous Address State & Zip:
Previous Address Length of Residency:
Do you have the legal right to work in the United States:
Can you provide proof of age:
Have you ever worked for this company before?

Yes No
If so, where? :
If so, start date? :
If so, when did you leave? :
If so, rate of pay? :
If so, position? :
If so, reason for leaving? :
Are you now employed? :
If not, how long since last employment? :
Who referred you? :
Rate of Pay Expected:
Have you ever been bonded (answer only if a job requirement):
Name of Bonding Company:
Have you ever been convicted of a felony? :
If yes, please explain:
Is there any reason you might be unable to perform the functions of the job for which you have applied:
If yes, explain if you wish:

Former Employers

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state, and zip code.

Applicants to drive a commercial motor vehicle in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)

*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

Employer

Name of Present or Last Employer:
Address:
City:
State:
ZIP:
Starting Date:
Leaving Date:
Job Title:
Weekly Starting Salary:
Weekly Final Salary:
May We Contact Your Supervisor?

Yes No
Name of Supervisor:
Title:
Phone:
Description of Work:
Reason for Leaving:
Did you drive a vehicle requiring a CDL? :

Employer

Name of Present or Last Employer:
Address:
City:
State:
ZIP:
Starting Date:
Leaving Date:
Job Title:
Weekly Starting Salary:
Weekly Final Salary:
May We Contact Your Supervisor?

Yes No
Name of Supervisor:
Title:
Phone:
Description of Work:
Reason for Leaving:
Did you drive a vehicle requiring a CDL? :

Employer

Name of Present or Last Employer:
Address:
City:
State:
ZIP:
Starting Date:
Leaving Date:
Job Title:
Weekly Starting Salary:
Weekly Final Salary:
May We Contact Your Supervisor?

Yes No
Name of Supervisor:
Title:
Phone:
Description of Work:
Reason for Leaving:
Did you drive a vehicle requiring a CDL? :

Employer

Name of Present or Last Employer:
Address:
City:
State:
ZIP:
Starting Date:
Leaving Date:
Job Title:
Weekly Starting Salary:
Weekly Final Salary:
May We Contact Your Supervisor?

Yes No
Name of Supervisor:
Title:
Phone:
Description of Work:
Reason for Leaving:
Did you drive a vehicle requiring a CDL? :

Employer

Name of Present or Last Employer:
Address:
City:
State:
ZIP:
Starting Date:
Leaving Date:
Job Title:
Weekly Starting Salary:
Weekly Final Salary:
May We Contact Your Supervisor?

Yes No
Name of Supervisor:
Title:
Phone:
Description of Work:
Reason for Leaving:
Did you drive a vehicle requiring a CDL? :

Employer

Name of Present or Last Employer:
Address:
City:
State:
ZIP:
Starting Date:
Leaving Date:
Job Title:
Weekly Starting Salary:
Weekly Final Salary:
May We Contact Your Supervisor?

Yes No
Name of Supervisor:
Title:
Phone:
Description of Work:
Reason for Leaving:
Did you drive a vehicle requiring a CDL? :

Accident Records

Accident records for past 3 years or more (attach sheet if more space is needed) If none, write NONE.

Accident Records

Date, Nature of Accident(Head-On,Rear-End, Upset, Etc), Fatalaties, Injuries of Last Accident:
Date, Nature of Accident(Head-On,Rear-End, Upset, Etc), Fatalaties, Injuries of Next Previous Accident:
Date, Nature of Accident(Head-On,Rear-End, Upset, Etc), Fatalaties, Injuries of Next Previous Accident:

Traffic Convictions

And forfeitures for the past 3 years (other than parking violations) If none, write NONE.

Accident Records

Location, Date, Charge, & Penalty of Last Traffic Conviction:
Location, Date, Charge, & Penalty of Next Previous Traffic Conviction:
Location, Date, Charge, & Penalty of Next Previous Conviction:

Education

Highest Grade Completed:
High School Grade Completed:
College Grade Completed:
Last School Attended (name & city):

Experience & Qualifications - Driver

And forfeitures for the past 3 years (other than parking violations) If none, write NONE.

Driver Licenses

State, License No, Type, Expiration Date:
State, License No, Type, Expiration Date:
State, License No, Type, Expiration Date:
A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle? :
B. Has any license, permit, or privilege ever been suspended or revoked:
If the answer to A or B is yes, give details:

Driving Experience (If none, write "NONE")

Class of Equipment

Straight Truck (Type of Equipment, From/To Date, Approx Number of Total Miles):
Tractor and Semi-Trailer (Type of Equipment, From/To Date, Approx Number of Total Miles):
Tractor-Two Trailers (Type of Equipment, From/To Date, Approx Number of Total Miles):
Motorcoach - Schoolbus (Type of Equipment, From/To Date, Approx Number of Total Miles):
Other (Type of Equipment, From/To Date, Approx Number of Total Miles):
List states operated in for last five years:
Show special courses or training that will help you as a driver:
Which safe driving award do you hold and from whom?:

Experience and Qualifications - Other

Show any trucking, transportation, or other experience that may help in your work for this company:
List courses and training other than shown elsewhere in this application:
List special equipment or technical materials you can work with (other than those already shown):

To be read and signed by applicant:

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 make such investigation and inquiries of my personal, employment, financial, or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

Date:
Applicant Signature: