Fillable Printable Target Drivers Employment Application Form
Fillable Printable Target Drivers Employment Application Form
Target Drivers Employment Application Form
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HR-34
D RIVERS E MPLOYMENT A PPLICATION
We are an equal opportunity employer, dedicated to a policy of nondiscrimination in employment on any
basis including race, creed, color, age, sex, religion, natural origin, or other protected classification.
• PERSONAL I NFORMATION •
Please PRINT clearly and use black or blue ink only.
Date
Name Social Security#
Other names used in employment
Present Address
Home Phone Number ( ) Cell Phone Number: ( )
Driver’s License No. State Exp. Date
If hired, can you provide proof of age?
STREET
CITY STATE ZIP
SANTA FE SPRINGS HOME OFFICE:
15415 Marquardt Avenue, Santa Fe Springs, CA 90670 · 800-352-3870 · 562-802-1786 fax
A NON-SMOKING FACILITY
TEMPE, AZ
1059 West Geneva Dr.
Tempe, AZ 85282
800-352-5548
Fax 480-517-0766
DALLAS, TX
10539 Maybank Dr.
Dallas, TX 75220
800-345-9387
Fax 214-357-4541
HOUSTON, TX
1225 N Post Oak Rd.
Houston, TX 77055
800-901-9746
Fax 713-682-4374
SAN ANTONIO, TX
5042 Service Center Dr.
San Antonio, Tx 78218
800-925-3922
Fax 210-662-8686
AUSTIN, TX
404 W Powell Lane Ste 407
Austin, TX 78753
800-896-1259
Fax 512-835-6917
OKLAHOMA CITY, OK
220 NW 67th St.
Oklahoma City, OK 73116
800-522-9701
Fax 405-848-2291
F
RESNO, CA
2478 N. Sunnyside Ave.
Fresno, CA 93727
800-827-4389
Fax 559-291-2433
S
AN JOSE, CA
1155 Mabury Rd.
San Jose, CA 95133
800-767-0719
Fax 408-287-2004
S
AN MARCOS, CA
431 Daisy Lane
San Marcos, CA 92078
800-237-5233
Fax 760-471-3351
S
ACRAMENTO, CA
524 Galveston St.
W
. Sacramento, CA 95691
800-533-0816
Fax 916-374-0900
L
AS VEGAS, NV
3455 W. Lake Mead Blvd.
N
. Las Vegas, NV 89032
866-472-3695
Fax 702-638-8515
P
ORTLAND, OR
13010 NE David Circle
Portland, OR 97230
877-827-4381
Fax 503-252-2782
REV 10/10
• EMPLOYMENT D ESIRED •
Position
Salary desired
Date you are available
Are there any hours, shifts, or days you cannot or will not work?
How did you learn of this opening?
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• PREVIOUS E MPLOYMENT •
Name of Employer
Address Telephone ( )
Position Salary
Reason for leaving
Name of Supervisor May we contact? ( ) Yes ( ) No
Title
Were you subject to the FMCSRs while employed?
o Yes o No
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and
alcohol testing requirements of 49CFR part 40? o Yes o No
FROM
TO
/
/
Name of Employer
Address Telephone ( )
Position Salary
Reason for leaving
Name of Supervisor May we contact? ( ) Yes ( ) No
Title
Were you subject to the FMCSRs while employed? o Yes o No
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and
alcohol testing requirements of 49CFR part 40? o Yes o No
FROM
TO
/
/
HR-34
Please list all of your residences during the last 10 years. Begin with your current residence.
Address of Residence City, State & Zip Code
D
ates
From
Month/Year
To
Month/Year
I
f rented, give name & address of
t
he person responsible for the
collection of rent
–3–
HR-34
Traffic Convictions and forfeitures for the past three years (other than parking violations). If none, write none.
(Attach sheet of more space is needed)
Location Date Charge
Penalty
Experience and Qualifications - Driver
List all driver licenses or permits held in the past 3 years.
State
Driver
Licenses
License No. Type
Expiration Date
Dates
Nature of Accident
(
Head-on, Rear-end, Upset, Etc.)
Fatalities
Injuries
H
azardous
M
aterial Spill
• MOTOR V EHICLE O PERATION •
Accident Record for past three years or more (Atach sheet if more space is needed). If none, write none.
A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?
o Yes o No
B. Has any license, permit or privilege ever been suspended or revoked? o Yes o No
C. Current Medical Card up to date? o Yes o No
If the answer to either A or B is Yes, give details?
Last Accident / /
Next Previous / /
Next Previous / /
Next Previous / /
Name of Employer
Address Telephone ( )
P
osition Salary
R
eason for leaving
Name of Supervisor May we contact? ( ) Yes ( ) No
Title
Were you subject to the FMCSRs while employed? o Yes o No
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and
alcohol testing requirements of 49CFR part 40?
o Yes o No
FROM
TO
/
/
–4–
HR-34
List states operated in the last five years:
List special equipment or technical materials you can work with (other than those already shown):
Location
City State
Majors and Minors
Sem.
or
Qtr.
No. of
Units
Earned
Degree or
Certificate
Received
• EDUCATION •
Circle Highest Grade Completed: 1 2 3 4 5 6 8 High School: 9 10 11 12
List the names and locations of Colleges or Business/Trade School attended (Include any related courses or training received)
If a License or Certificate is required for this position, list those which you possess with dates of expiration.
License or Certificate
Date Issued Date Expires
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 thre
and complete to the best of my knowledge.
Date Applicant’s Signature
Driving Experience - check Yes or No
D
ates
F
rom
Month/Year
A
pprox. no of miles
(
Total)
F
rom
M
onth/Year
C
ircle Type of Equipment
C
lass of Equipment
S
traight Truck
o Y
es
o N
o Van, Tank, Flat, Dump, Refer
Tractor and Semi-Trailer
o Yes o No Van, Tank, Flat, Dump, Refer
Tractor - Two Trailers
o Yes o No Van, Tank, Flat, Dump, Refer
Tractor - Three Trailers
o Yes o No Van, Tank, Flat, Dump, Refer
M
otocoach - School Bus
o Y
es
o N
o-
Motocoach - School Bus
o Yes o No -
Other
More than 7
passangers
M
ore than 15
p
assangers
