COMMERCIAL DRIVER APPLICATION FOR EMPLOYMENT
Use this application when applying for a commercial driving position. For all other positions, use the form titled “Application for Employment”. Please legibly print all information requested. Completed applications may be returned by: Mail: Skagit Farmers Supply Attn: Human Resources E-mail: HR@skagitfarmers.com PO Box 266 Burlington, WA 98233
Today’s Date:
Last Name	First Name	Middle Name	Maiden Name
Present address: Street City State Zip	How long at current address?
Previous address if less than three years: Street City State Zip
Telephone Number:	Email Address:	Are you under Yes age 18? No	Are you 21 Yes or older? No	Are you currently authorized Yes to work in the united states? No Proof of eligibility will be required if hired.
Position applied for:	Wage desired: $
Location: Propane – Burlington, WA Agronomy – Burlington, WA AFCO Distribution – Burlington, WA Bulk Fuel – Burlington, WA Agronomy– Conway, WA AFCO Distribution – Spokane, WA
Days available to work: Sun Mon Tues Wed Thurs Fri Sat	Hours per week available to work:
Employment desired: Full Time Only Part Time Only Full or Part Time Seasonal	When are you available to start work?
Have you ever applied to or worked Yes for the company before? No	If “yes”, please explain (include date):
Do you have any friends, relatives or Yes acquaintances working for the company? No	If “yes”, state name and relationship:
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? Yes No If no, describe the functions that cannot be performed:
The company complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to medical examination conducted by a medical professional.
EDUCATION
High School Name Mailing Address	Years Completed	Yes No Did you graduate?	Diploma GED Did not finish
College Name Mailing Address	Years Completed	Yes No Did you graduate?	Major or Degree
Business or Trade School Name Mailing Address	Years Completed	Yes No Did you graduate?	Major or Degree
MILITARY
Have you ever served Yes in the armed forces? No	If “yes,” Date Entered: Date Discharged:	Specialty:	Are you currently a member Yes of the National Guard? No
DRIVING HISTORY
Do you currently possess a valid Yes commercial driver license? No	If yes, please check A applicable class: B C	Please check applicable Hazmat (H or X) Doubles/Triples (T) endorsements: Tank Vehicle (N or X) Air Brake Restriction (K)
Have you had any suspensions or Yes revocations in the last three years? No	Have you had any DUI, DWI, BAC, controlled substance Yes or open container convictions in the last five years? No	Have you had any of the following violations in the last three years? (check all that apply) 20 mph or more over the speed limit. Racing / exhibition driving. Careless, reckless or imprudent driving.
What is your means of transportation to work:
Accident Record: List all accidents for the past three years. Attach an additional sheet if more space is needed. If none, write “none”.
Date	Nature of Accident (head-on, rear-end, upset, etc.)	Injuries	Fatalities	Hazardous Material Spill
1. Last Accident:	Yes No
2. Next Previous:	Yes No
3. Next Previous:	Yes No
Traffic Convictions: List all moving violations and forfeitures for the past three years. Attach an additional sheet if more space is needed. If none, write “none”.
Location	Date	Charge	Penalty
1.
2.
3.
Driver License History: List all driver licenses or permits held in the past three years. Attach an additional sheet if more space is needed.
State of Issue	License Number	Type	Endorsements	Restrictions
Current:
Previous:
Previous:
A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No B. Has any license, permit or privilege ever been suspended or revoked? Yes No If the answer to either A or B is yes, give details:
List states operated in for the last five (5) years:
Driving Experience: Class of Equipment	Type of equipment (van, tank, flat, etc.)	Dates	Approx. # of miles (total)
From	To
Straight Truck
Tractor / Semi-Trailer
Tractor & Two+ Trailers
Other:
COMPUTER SKILLS
Typing: Yes WPM: No	Word Yes Processing: No	Spreadsheets: Yes No	10-Key: Yes No
Please list specific computer applications / programs or other skills here:
REFERENCES
Please list two references other than relatives:
Name:	Name:
Relationship:	Relationship:
Address:	Address:
Phone #:	Phone #:
IN CASE OF EMERGENCY CONTACT
Name:	Relationship:	Phone #:
Address:
OTHER INFORMATION
Please use this space to elaborate on any background, experience or qualifications that you believe should be considered in evaluating your qualifications for employment. You may include hobbies, volunteer experience and any other activities you believe relevant. Please omit any information that would disclose your race, gender, age, marital status, ethnic origin, religious or political affiliations, or disability.
WORK EXPERIENCE
Please list your work experience beginning with your most recent job held. The Federal Motor Carrier Safety Administration (FMCSA) requires that employment for at least three (3) years and/or Commercial Driving experience (CDL) for the past ten (10) years be shown. If you were self-employed, give business name. Resumes are not accepted in lieu of completing the work history listed on pages 3 – 5 (please do not write “see resume”; however, they are accepted as a supplement to this application. Please explain any gaps in work history. Attach additional sheets if necessary.
Employer Name:	Your Job Title:	Employment Dates: From: To:
Address: Street City State Zip
Phone:	Contact Person:	Name & Title of Last Supervisor:	May we contact Yes this employer? No
Reason for leaving:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked with this company:
Employer Name:	Your Job Title:	Employment Dates: From: To:
Address: Street City State Zip
Phone:	Contact Person:	Name & Title of Last Supervisor:	May we contact Yes this employer? No
Reason for leaving:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked with this company:
Employer Name:	Your Job Title:	Employment Dates: From: To:
Address: Street City State Zip
Phone:	Contact Person:	Name & Title of Last Supervisor:	May we contact Yes this employer? No
Reason for leaving:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked with this company:
Employer Name:	Your Job Title:	Employment Dates: From: To:
Address: Street City State Zip
Phone:	Contact Person:	Name & Title of Last Supervisor:	May we contact Yes this employer? No
Reason for leaving:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked with this company:
APPLICATION STATEMENT
Did you complete this application yourself? Yes No If not, who did?
As indication that you have read and understood each sentence, please write your initials in the spaces provided below. If you are submitting this application electronically, your initials and signature will be required upon hire. In exchange for the consideration of my job application by Skagit Farmers Supply (also known as “AFCO Distribution & Milling” or “The Country Store”), (hereinafter called “the Company”), I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, _____ or to confer any right to remain an employee of the Company, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, _____ and that relationship cannot be altered except by a written instrument signed by the CEO or Board of Directors of the Company._____ Both the undersigned and the Company may end the employment relationship at any time, without specified notice or reason._____ If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits._____ I authorize investigation of all statements contained in this application. _____ I understand that the misrepresentation or omission of facts called for may be cause for dismissal at any time without any previous notice. _____ I hereby give the Company permission to contact schools, all previous employers (unless otherwise indicated), references and others and herby release the Company from any liability as a result of such contact. _____ I understand that, in connection with the routine processing of your employment application, the company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics and mode of living. _____ Upon written request from me, the Company will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act. _____
Signature of Applicant	Date
Skagit Farmers Supply and its brands (also known as AFCO Distribution & Milling or The Country Store) is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with AFCO Distribution & Milling depends solely on your qualifications. Thank you for completing this application and for your interest in our company.