Talon Logistics - Application for Employment

Do you have a driver's license? *

Yes No
What is your means of transportation to work?
Driver's License Number *
State of Issue *
Type? *

Operator Commercial (CDL) Chauffeur
Expiration Date *

Month Day Year
Have you had any accidents during the past three years? *

Yes No
How many?
Have you had any moving violations during the past three years? *

Yes No
How many?
References

Please list two references other than relatives or previous employers.
Full Name *

First Name Last Name
Position *
Company *
Address *
Phone Number *

Area Code Phone Number
Full Name *

First Name Last Name
Position *
Company *
Address *
Phone Number *

Area Code Phone Number
An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

Have you ever been in the armed forces? *

Yes No
Are you now a member of the National Guard? *

Yes No
Specialty:
Date Entered

Month Day Year
Discharge Date

Month Day Year
Work Experience

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name.
Employer Name *
Start date *

Month Day Year
Ending date *

Month Day Year
Position Held *
Salary/Wage *
Reason for leaving *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Contact Person *
Contact Phone *

Area Code Phone Number
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company. *
Next Employer
Employer Name
Start date

Month Day Year
Ending date

Month Day Year
Position Held
Salary/Wage
Reason for leaving
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Contact Person
Contact Phone

Area Code Phone Number
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Next Employer
Employer Name
Start date

Month Day Year
Ending date

Month Day Year
Position Held
Salary/Wage
Reason for leaving
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Contact Person
Contact Phone

Area Code Phone Number
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Next Employer
Employer Name
Start date

Month Day Year
Ending date

Month Day Year
Position Held
Salary/Wage
Reason for leaving
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Contact Person
Contact Phone

Area Code Phone Number
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Next Employer
Employer Name
Start date

Month Day Year
Ending date

Month Day Year
Position Held
Salary/Wage
Reason for leaving
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Contact Person
Contact Phone

Area Code Phone Number
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
May we contact any of your employers?

Yes No
Did you complete this application yourself?

Yes No
If not, who did?

CONSUMER REPORT DISCLOSURE & RELEASE (EMPLOYMENT)

DISCLOSURE

In conjunction with your employment or application for employment (including contract for services), consumer reports may be requested from USIS Commercial Services ("USIS"). These reports may include the following types of information: names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic history, professional credentials and drug/alcohol use. Such reports may contain public record information concerning record, worker' compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records, as well as information from USIS concerning previous driving record requests made by others from such state agencies and state provided driving records.

You have the right to make a request to USIS, upon proper identification, to request the nature and substance of all infromation in its files on you at the time of your request, including the sources of information and the recipients of any reports on you that USIS has previously furnished within the two-year period preceding your request. USIS may be contracted by mail at P.O. Box 331881, Tulsa, Oklahoma 74153, or by phone at 800-381-0645.
Oklahoma Applicants Only: I request a copy of any credit report requested on me. Minnesota Applicants Only: I request a copy of any consumer report requested on me.
RELEASE

I AUTHORIZE, WITHOUT ANY RESERVATIONS, USIS, AND ANY PARTY OR AGENCY CONTRACTED BY USIS, TO FURNISH THE ABOVE MENTIONED INFORMATION.

USIS is authorized to disclose all information obtained to the requesting entity for the purpose of making a determination as to my eligilbility for employment, promotion or any other lawful purpose. I agree that such infromation which USIS has or obtains, and my employment history or contractor if I am hired or contracted, may be supplied by USIS to other companies that subscribe to USIS. If hired or contracted, this authorization shall remain on file and shall serve as ongoing authorizationfor the procurement of consumer report at any time during my employment or contract period.
*

By checking this box, I certify that I have read and fully understand this release, that prior to checking the box I was given an opportunity to ask questions and to have those questions answered to my satisfaction, and that I executed this release voluntarily and with the knowledge that the information being released could affect my being hired, my employment or my eligibility for promotion.
Notice to California Applicants

Under California law, the consumer reports we order on you for employments purposes within the State of California are defined as invesitgative consumer reports. These reports may contain information on your character, general reputation, personal characteristics and mode of living.

Under Section 1786.22 of the California Civil Code, you may view the file maintained on you by USIS during normal business hours. You may also obtain a copy of this file upon submitting proper identification and paying the costs of dupication services, by appearing at USIS in person, by mail or by telephone. The agency is required to have personnel available to explain your file to you and the agency must explain to you any coded information appearing in your file. If you appear in person, a person of your choise may accompany you, provided that this person furnishes proper identification.
California Applicants Only - I request to receive a free copt of any invesigative consumer report ordered on me by checking this box
Should be Empty:

Phone 812-285-0219 Fax 812-285-0796

EDUCATION

References

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