1
A F Wholesale Transport
1983 Route 52
Hopewell Junction, lrly 12533
(84s) 76s_8s07
Please fax completed
application to (s45) 632-.626g /At6r: Hiring Manager
You may also mail in your applicaiionio
the above address.
**********{.************************:t**{.********t
****,i*************
Attention Applicants: please include copies of
your Social Security card, Driver,s License,
TWIC Card and DOT MedicalCard with your
application.
www.snkpeEo.com
DRN/ERIS
APPLICATION FOR EMPLOYMENT
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ETPLOYTEilT HISTORY
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LAST FN'E TEARS
S{OIY SPECIA COIJRSES OR TR^6MG I}NTW[.L }E,P YOU AS A DRII/R
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YES
YES
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AF Wholesale Transport INC DOT Drug Testing Consent Fom
As a part of my application for employment as a driver of a commercial motor vehicle for AF
Wholesale Transport INC, I consent to a drug test.
of my specimen will be done in accordance
with DOT regulations. If I am taking any prescription medication at the time of my drug test and
my test comes back positive for illegal dnrgs, I will be afforded an opportunity to discuss that with
I
understand that the collection, testing, and reporting
an MRO for the purpose of providing a reasonable explanation of my positive drug test.
I
understand
that if my test remains positive for illegal drugs I will not be offered
employment.
I consent to the release of my drug test results received by Minert &
Associates, Inc., as the
repesentative of ttre Medical Review Officer, to management officials at AF Wholesale Transport
INC and undersand that those test results will be held in confidence, by all parties involved.
also understand that if I have a positive drug test and am subsequently fired because of that
positive test, I waive dl righa to receiving unemployment benefits and insurance, and will be
responsible for all incurred attomey fees if I choose to contest this firing because of my positive
dnrg test.
I
I furttrer consent to AF Wholesale Transport INC contacting those employers for whom I
have
worked as a commercial vehicle op€rator for the past two (2) years for the purpose of the company
determining from those employers whether I have tested positive for illegal drugs or alcohol, or
have refused to test when requested to do so. [n the event that the company receives information
from such a past employer that I have tested positive for drugs or alcohol within the las year, I
undentand that I will not be offered employment, or my conditional employment with the company
will be terminated. I consent to the release of that information by those employers for whom I have
worked during the past two (2) years as a commercial vehicle driver.
read, and undersand the terms of AF Wholesale Transport INC Drug Free
Workplace testing progr:rm, and agree to abide by those terrns.
I have received,
Applicant's Name (Print)
Applicant's Signature
Date
A F Wholesale TransPort
1983 Route 52
Hopewell Junction, l.IY 1 2533
(845) 76s-8s07
gve my permission for
A F Wholesale Transport to make any investigation of my personal history, including but not
limited to a driver's license history, military record and criminal background check from the
State ofNew York upon consideration for employment or at any time after emplolment.
Date:
Signature:
Current Address:
Street Address CiW State ZiP
Phone #:
Dates
Street Address City State ZiP
Dates
Street Address CiW State ZiP
State:
Driver's License #
Have you ever been convicted of a
May we contact your current
crime?
employer?
Yes
Yes
www.snkpetro.com
DOB
-J-J.
No
No
A F Wholesale Transport
1983 Route 52
Hopewell Junction, NIY 12533
(845) 76s-8s07
Name:
l.)
Date:
Figur€ the following gallon amounts:
l0o/o
of 9,200 gallons
gallons_
60Yoof 9,200 gallons_
30o/o
of 9,200
2.') If you load 1,500 gallons in a 2,900 gallon compartnent how
much more gasoline can you load in that compartmont?
3.) Your trailer is loaded
wifi
5,500 gallons of Unleaded
gasoline. You arrive at the destination and the Unleaded gas
tank has 3,fl)0 gallons of gns in it. The managpr tells you the
tank holds 8,000 gallons of gas. Will this load fit?
4.) Gasoline weighs 6.4 lbs. per gallon. Ao u-pty truck and
trailer weighs 25,000 lbs. You have been disparched witlt
8,600 gallons. Federal law regulates orn industry to E0,000
lbs. gross vehicle weight. Can you legally hansport this
load?
Yes
No
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A F Wholesale Transport
1983 Route 52
Hopewell Junction, NIY 12533
(84s) 76s-8s07
Essential Job Functions
o
o
- Truck Driver
Driver must be able to rea4 write and speak the English language sufficiently to converse with
the general public and to understand highway traffrc signals and signs in the English language.
The driver should have the ability to respond to inquiries, @mpany, and customer requests.
Driver must be able to complete daily logs and all necessary tip, fuel and damage r€ports, as well
as
otter paperwork required by the company in a legible mannor.
o
Driver must have a valid Class A Commercial Driven' License with Hazmat and Tanker
endonoments. Driver must follow all Statg and Federal Traffrc Laws.
.
Driver must be able to physically quahry, pass a DOT drug and alcohol test and obtain
Medical.
o
for extended periods of time up to 14
consecutive hours, in all types of weather, while tansporting hazardous or non-hazardous
material.
o
Driver must be able to safely walk, ben4 reach, push, pull, $@p, squaL and kneel and climb, as
necessary, to perform vehisle inspections required tmder section 396.13 ofthe Federal Motor
Carrier Safety Regulations or in accordance with company procedures, customer requirements
and /or as circumstances dictate.
.
Driver must be able to safely grasip, lift as high as above the hea4 carry and handle heavy
equipment up to 50lbs. as necessaq/ to ensure efficient operation and safety duing both the
loading and unloading process of truck operation.
fhiver must be able to drive and operate
a
DOT
a fiactor
o
Driver also must be able to climb upon trailer when tha situation deems necessary and wittr due
care if dome lids need inspection. The Driver must report any suspeoted damageJaccidentJspills
involving the equipment.
o
Driver must be able to report for dispatch at time specified, maintain contact with dispatch offices
as required and perform duties and deliveries assigned in a proper and timely fashion in company
issued uniform.
o
The drivers must function as a bam which includes proper communication and cleanliness of the
equipment
www.snkpetro.com
A F Wholesale Tranqport
1983 Route 52
Hopewell Junction, NY 12533
(84s) 76s-8s07
Afterreviewing the above mentioned essential job firnctions, is there anything that would
prevent you from performing such functions?
No
Yes
lf
yes,
identiS the job function(s) you cannot perform:
Neither the completion of this form, acceptance of it by the company, nor the subseque,nt e,lrtry
into any kind of employment relationship, shall serve to create an actual el implied conhact
of
emplolment or confer any right to remain an employee of A F Wholesale Transport or
otherwise change in any respect the employm.ent
-
at
-
wiU relationship betrveen the company
and the undersigned. This relationship cannot be altered except by a
written instrument signed by
the Owner of the company. Both the undersigned and A F Wholesale Tmnsport may end the
employment relationship at any time, without specified notic€, reason, and without liabiltty by
A
F Wholesale Transport to the undersigned for earned wages or salary. I have read
understand and completed this form and certift that it was completed by me, and that the enties
and information on
it are tue and complete. I further understand that any false, incomplete, or
deceptive response made by me on this form shall be ground for denial of employrnent or
discharge.
Signature:
www.snkpetro.com
& DRI|G TESil
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REQUEST FOR INFORT$ATION
rom Previous EmPloYer
itbmdon
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THIS FORM WAS (ch€d(.apprcptbb
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Statc of
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Employment Eligibility Verification
IJSCIS
Form I-9
Department of Homeland Security
OMB ltlo. 1615-0047
U.S. Citizenship and Immigration Services
Expires 0313112016
>START HERE. Read instructions carefully before completing this form. The instructions must be available during completic,n of this form.
ANTI-DISCRIMINATION NOTIGE: lt is illegal to discriminate against work-authorized individuals Employers CANNOT specify which
document(s) they will accept from an employee. The refusal to hire an individual because the documentation presented has a future
expiration date may also constitute illegal discrimination.
Section 1. Employee Information and Aftestation
@mployees must complete and sign Sectlon 1 of Form l-9 no later
than the first day of employment, but not before accepting a job offer.)
Last Name (Family Name)
First Name (Given
Address (Street Number and Name)
Date of Birth (mm/dd/yyw)
Name)
Apt. Number
U.S. Social Security Number
Middle Initial Other Names Used (if any)
City or Town
State
Zip Cocle
Telephone Number
E-mail Address
L_1-L__l-L
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in
connection with the completion of this form.
aftest, under penalty of perjury, that I am (check one of the following):
I
!
l-l
!
A citizen of the United States
l_J
An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy)
A noncitizen national of the United States (See instructions)
A lawful permanent resident (Alien Registration Number/USCIS Number)
. Some aliens may write "N/A" in this field
(See instructions)
For aliens authorized to work, provide your Alien Registration Number/USCIS Number OR Form l-94 Admission Number:
1. Alien Registration Number/USCIS Number:
3-D Barcode
Do Not Write in This Space
OR
2. Form l-94 Admission Number:
lf you obtained your admission number from CBP in connection with your arrival in the United
States, include the following:
Foreign Passport Number:
Country of lssuance
Some aliens may write "N/A" on the Foreign Passport Number and Country of lssuance fields. (See instructions)
Date (mn/dd/yyw):
Signature of Employee:
Preparer and/or Translator Certification (To be completed and signed if Section
1 is
prepared by a person other than the
employee.)
attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my kno'wledge the
information is true and correct.
I
Date (nm/dd/yyyy):
Signature of Preparer or Translator:
Last Name (Family Name)
Address (Street Number and Name)
First Name (Given Name)
City or Town
State
Zip Code
Employer Completes Nert Page
FormI-9 03/08/13
N
PageT
of9
Section 2' Employer or Authorized Representative Review and Verification
(Employers or their authorized representative must complete and sign section 2 within
3 business days of the employee's first day of enrployment. you
must physically examine one document from List A OR examine a combination of one
document from List B and one document frcm Lrsl C as listed on
the ?rbfs of Acceptable Documents" on the next page of this fom. For each document you review, record
the foilowing information: doctument titte,
issuing authoity, document number, and expiration date, if any.)
Employee Last Name,
Fist
Name and Middle Initial from Section 1:
List A
List B
ldentity and Enlployment Authorization
List C
ldentity
Employment Authorization
Document Tille;
Document Title
Document Title:
ssuing Authority:
lssuing Authority:
lssuing Authority:
Document Number:
Document Number:
Document Number:
Expiration Date (if any) (mn/dd/yyyy):
Expiration Dale (it any) (n m/dd/yyyy):
Expiration
D
aIe (if a ny) (mm/dct/yyyy):
Document Title:
lssuing Authority:
Document Number:
Explratlon Date (if any)
(m
m/dd/yyw):
3-D Barcode
Do Not Write in This Space
focument Title:
lssuing Authority:
Document Number:
Expiration Date (if
any) ( m m/dd/yyyy):
Certification
I aftest, under penalty of perjury, that (1) | have examined the document(s) presented by the above-named employee,
(2) the
above-listed document(s) appear to be genuine and to relate to the employee named, anO (S) to the best of my knowiedge
the
employee is authorized to work in the United States.
The empfoyee's first day of employment (mm/dd/yyyy):
Signature of Emplover or Authorized Representative
Last Name (Family
Name)
(See rnsfructio ns for exemptions.l
Date (mm/dd/yyw)
First Name (Given Name)
Title of Employer or Authorized Representative
Employer's Business or Organization Name
Employer's Business or Organization Address (Street Number and Name) City or Town
State
Zip Code
3. Reverification and Rehires
New Name (if applicable) Last Name (Family
(To be completed and signed by emptoyer or authorized representative.)
,mftldd/rryyy)
Nane) First Name (Given Name)
C. lf employee's previous grant of employment authorization has expired, provide the information for the document from List A or List C the emprlo@
presented that establishes current employment authorization in the space orovided berow.
Document Title:
Document Number:
Expiration Date (if any) (mm/dd/yyyy):
I attest' under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United Stat,es, and if
the employee presented document(s), the document(s) | have examined appear to be genuine and to relate to the individual.
Signature of Employer or Authorized
Form
I-9
03/08/13 N
Representative:
I Dale
(mm/dd/yyw):
lPrint Name of Employer or Authorized Represenllative:
Page 8
of9