Pacific CA Systems Pacific CA Services

Apply Online

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered or all positions without regard to race, color, religion, sex, national origin, age, marital status, or non-job related disability.

Applicant Information

First Name: Middle Name: Last Name: Phone Number: Email Address: Current Address: Address 2: City: State: Zip: How long have you lived at your current address? Previous Address: Address 2: City: State: Zip: How long did you live at this address?

Personal Information

Do you have the legal right to work in the United States? Date of Birth (Required for commercial drivers): Can you provide proof of age? Have you worked for this company before? If yes, please give date and location: Position: Employed from: through: Reason for Leaving: Are you currently employed? If not, how long since leaving last employment? Who referred you? Rate of pay expected? Is there any reason you might be unable to perform the functions of the job for which you have applied [as described in the attached job description]? If yes, explain if you wish:

Employment History

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 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.)

Most Recent Job

Company: Address City State Zip Contact Person Phone Number Employed from: through: Position Held: Salary/Wage Reason for Leaving

Job 2

Company: Address City State Zip Contact Person Phone Number Employed from: through: Position Held: Salary/Wage Reason for Leaving

Job 3

Company: Address City State Zip Contact Person Phone Number Employed from: through: Position Held: Salary/Wage Reason for Leaving

Job 4

Company: Address City State Zip Contact Person Phone Number Employed from: through: Position Held: Salary/Wage Reason for Leaving

Job 5

Company: Address City State Zip Contact Person Phone Number Employed from: through: Position Held: Salary/Wage Reason for Leaving

Job 6

Company: Address City State Zip Contact Person Phone Number Employed from: through: Position Held: Salary/Wage Reason for Leaving

Job 7

Company: Address City State Zip Contact Person Phone Number Employed from: through: Position Held: Salary/Wage Reason for Leaving

Job 8

Company: Address City State Zip Contact Person Phone Number Employed from: through: Position Held: Salary/Wage Reason for Leaving

* Includes vehicles having 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.

ACCIDENT RECORD FOR PAST 5 YEARS

IF NONE, WRITE NONE

Date of Accident: Nature of Accident (head-on, rear end, upset, etc.): Fatalities: Injuries:

Date of Accident: Nature of Accident: Fatalities: Injuries:

Date of Accident: Nature of Accident: Fatalities: Injuries:

Experience & Qualifications - Driver Licenses

State Issued: License Number: Type: Expiration Date:

State Issued: License Number: Type: Expiration Date:

State Issued: License Number: Type: Expiration Date: Have you ever been denied a license, permit or privilege to operate a motor vehicle? If yes, please explain: Has any license, permit or privilege ever been suspended or revoked? If yes, please explain:

Driving Experience

If none, leave blank

Straight Truck

Type of Equipment (Van, tank, flat, ect.) Dates Approx. No. Miles (Total)

Tractor / Semi-Trailer

Type of Equipment Dates Approx. No. Miles (Total)

Tractor / Two Trailers

Type of Equipment Dates Approx. No. Miles (Total)

Motor Coach / School Bus

Type of Equipment Dates Approx. No. Miles (Total)

Other

Type of Equipment Dates Approx. No. Miles (Total) List states operated in for past five years Special courses or training that will help you as a driver: Which safe driving awards do you hold and from whom?

Experience and Qualifications - Other

List 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)

Upload Documents

Résumé

By submitting this form I certify 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 investigations and inquires of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (generally, inquires 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 inquires 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.

Address

1420 Industrial Way
Union Gap, Washington, USA 98903
Get Directions

Contact Us

Phone: 509.576.8632
Toll-Free1.800.354.5185
(Toll-Free in North America)

Another website made with Invisible Ink