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

RESNO, CA

2478 N. Sunnyside Ave.

Fresno, CA 93727

800-827-4389

Fax 559-291-2433

AN JOSE, CA

1155 Mabury Rd.

San Jose, CA 95133

800-767-0719

Fax 408-287-2004

AN MARCOS, CA

431 Daisy Lane

San Marcos, CA 92078

800-237-5233

Fax 760-471-3351

ACRAMENTO, CA

524 Galveston St.

. Sacramento, CA 95691

800-533-0816

Fax 916-374-0900

AS VEGAS, NV

3455 W. Lake Mead Blvd.

. Las Vegas, NV 89032

866-472-3695

Fax 702-638-8515

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

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

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

ates

From

Month/Year

f rented, give name & address of

he person responsible for the

collection of rent

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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

azardous

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 / /

Name of Employer

Address Telephone ( )

osition Salary

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

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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.

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

ates

rom

Month/Year

pprox. no of miles

(

Total)

rom

onth/Year

ircle Type of Equipment

lass of Equipment

traight Truck

o Y

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

otocoach - School Bus

o Y

o N

Motocoach - School Bus

o Yes o No -

Other

More than 7

passangers

ore than 15

assangers