Online Employment Application -

Applicant's Information

Name*

Applicant's E-Signature:*

Date*

Positions Applied for:*

Do you know any current Alpine Employees?

List Names

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Date you can start:*

Rate of Pay Expected:*

Previous Three years of Residency

List past 3 years of residency*

Include address and # of years at that address

General Information

Can you provide proof of Age?*

Yes
No

Do you have the legal right to work in the US?*

Yes
No

Have you worked for this company before?*

Yes
No

Where?

Dates From:*

To:*

Position:*

Reason for Leaving:*

Education

(Enter highest grade completed)

High School

College

Other Education

Safety Training/Certificates:

References

(give names of three persons you are not related to, whom you have known for at least one year and we can contact. )

Name-1*

Address -1*

Phone-1*

Occupation-1*

Name-2*

Address -2*

Phone-2*

Occupation-2*

Name-3*

Address -3*

Phone-3*

Occupation-3*

Have you been convicted of a Felony within the last 5 Years?*

Yes
No

If yes, please explain below, will not necessarily exclude you from consideration .

Felony Explanation

Service Record

Branch of Service

Discharge Date & Rank

Employment Record

Applicants that desire to drive in intrastate/interstate commerce with a CDL requires 10 previous years of employment history, all other employees we prefer to see at least 5 years.

Previous Employer 1:

(List Previous employers starting with the most recent)

Company name:*

Supervisor:*

Address*

Phone*

Position Held:*

Dates Employed- From:*

To:*

Reason for Leaving: (required)*

Any Gaps in employment and/or Unemployment*

Include Dates (month/year) and Reason:

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the pervious employer?*

Yes
NO

Was the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40?*

Yes
NO

Previous Employer 2:

(List Previous employers starting with the most recent)

Company name:

Supervisor:

Address

Phone

Position Held:

Dates Employed- From:

To:

Reason for Leaving: (required)

Any Gaps in employment and/or Unemployment

Include Dates (month/year) and Reason:

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the pervious employer?

Yes
NO

Was the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40?

Yes
NO

Previous Employer 3:

(List Previous employers starting with the most recent)

Company name:

Supervisor:

Address

Phone

Position Held:

Dates Employed- From:

To:

Reason for Leaving: (required)

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the pervious employer?

Yes
NO

Was the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40?

Yes
NO

Need to add more employers?

Yes
No

Previous Employer 4:

(List Previous employers starting with the most recent)

Company name:

Supervisor:

Address

Phone

Position Held:

Dates Employed- From:

To:

Reason for Leaving: (required)

Any Gaps in employment and/or Unemployment

Include Dates (month/year) and Reason:

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the pervious employer?

Yes
NO

Was the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40?

Yes
NO

Previous Employer 5:

(List Previous employers starting with the most recent)

Company name:

Supervisor:

Address

Phone

Position Held:

Dates Employed- From:

To:

Reason for Leaving: (required)

Any Gaps in employment and/or Unemployment

Include Dates (month/year) and Reason:

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the pervious employer?

Yes
NO

Was the previous job position designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40?

Yes
NO

License Information

Section 383.21 FMSCR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license". I certify that I do not have more than one motor vehicle license, the information for which is listed below.

Date of Birth

(Commercial Drivers Only)

License State*

License Number*

License Class

License Endorsements

Have you ever been denied a license, permit or privilege to operate a motor vehicle?*

Yes
No

Please Explain

Has any license, permit or privilege ever been suspended or revoked?*

Yes
No

Please Explain

Number of years you've held a Commercial Drivers License (CDL)

List States operated in for the past five years:

Driving Experience

List Class of Equipment, Type of Equipment, Dates, Approx. No of Miles

Accident Record for Past 3 years or more

List Dates, Nature of Accident, Number of Fatalities, Number of Injuries, Hazardous Material Spills

Traffic Convictions and Forfeitures for the past 3 years (other than parking violations)

List Date Convicted, Violation, State, and Penalty.