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Applicationwebsupport@aspwv.com2019-10-23T13:15:08+00:00

Employment Application

Step 1 of 8

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First Name*
Middle Name*
Last Name*
Date*
Date Format: MM slash DD slash YYYY
In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job-related disability, or any other protected group status.
TO BE READ AND SIGNED BY APPLICANT
I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. Generally, inquiries 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 personnel from all liability in responding to inquiries 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.

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:
- · Review information provided by previous employers
- · Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer
- · Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.
Signature*

First Name*
Date*
Date Format: MM slash DD slash YYYY
Middle Name
Last Name*
Email Address*
Social Security Number*
Primary Phone Number*
Secondary Phone Number
Position Applying For
Expected Rate of Pay
Highest Grade Completed
Last School attended (Last city and state)

Employment Questionnaire
Do you have a CDL License?*
- Yes
- No
Do you have the legal right to work in the US?*
- Yes
- No
Have you worked for this company before?*
- Yes
- No
If yes, list dates of employment, rate of pay, and reason for leaving:
Are you currently employed?*
- Yes
- No
If no, how long since leaving your last employment?
Have you ever been convicted of a felony?*
- Yes
- No
If yes, please provide a short explanation:
If there are any reasons you might be unable to perform the functions of the job for which you are applying, you may list them here:

Employment History
Name of Previous Employer*
Position Held*
Salary
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Length of Employment (years)*
Address of Previous Employer
Street Address
Street Address Line 2
City
State
Zip Code
Contact name and number for previous job
Reason for leaving employment
Were you subject to the FMCR while employed?
- Yes
- No
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?
- Yes
- No
Previous Employer 2
Name of Employer 2
Position Held
Salary
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Length of Employment (years)
Address of Previous Employer 2
Street Address
Street Address Line 2
City
State
Zip
Contact name and number for previous job
Reason for leaving employment
Were you subject to the FMCR while employed?
- Yes
- No
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcogol testing requirements of 49 CFR part 4?
- Yes
- No
Current and E2
Previous Employer 3
Name of Previous Employer
Position Held
Salary
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Length of Employment (years)
Address of Previous Employer 3
Street Address
Street Address Line 2
City
State
Zip Code
Contact name and number for previous job
Reason for leaving employment
Were you subject to the FMCR while employed?
- Yes
- No
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?
- Yes
- No
Current and E2 and E3
Previous Employer 4
Name of Previous Employer
Position Held
Salary
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Length of Employment (years)
Address of Previous Employer 4
Street Address
Street Address Line 2
City
State
Zip Code
Contact name and number for previous job
Reason for leaving employment
Were you subject to the FMCR while employed?
- Yes
- No
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?
- Yes
- No

Driving Experience and Qualifications
Check all the vehicles you have experience driving:
- Straight Truck
- Tractor and Semi-Trailer
- Tractor - Two Trailers
- Tractor - Three Trailers
- Motorcoach - School Bus (More than 8 Passengers)
- Motorcoach - School Bus (More than 15 Passengers)
- Other
For each vehicle above, detail below the type of equipment, dates of experience, and approximate number of miles:
List states operated in for last 5 years:*
List any safe driving awards that you hold
Driving History
List your accident record and traffic conviction history for the past 3 years. *Do not list parking violations
Date of most recent accident
Date Format: MM slash DD slash YYYY
Nature of accident
Injuries?
- Yes
- No
Fatalities?
- Yes
- No
Hazmat spill?
- Yes
- No
List any fatalities and/or injuries
Date of Accident 2
Date Format: MM slash DD slash YYYY
Nature of Accident 2
Injuries?
- Yes
- No
Fatalities?
- Yes
- No
Hazmat spill?
- Yes
- No
List any fatalities and/or injuries
Date of Accident 3
Date Format: MM slash DD slash YYYY
Nature of Accident 3
Injuries?
- Yes
- No
Fatalities?
- Yes
- No
Hazmat spill?
- Yes
- No
List any fatalities and/or injuries

Traffic Conviction History
Date of 1st conviction
Date Format: MM slash DD slash YYYY
Location of incident
Charge
Penalty
Date of 2nd conviction
Date Format: MM slash DD slash YYYY
Location of incident
Charge
Penalty
Date of 3rd conviction
Date Format: MM slash DD slash YYYY
Location of incident
Charge
Penalty

Affidavit
My signature certifies 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.
Signature*
New Hire Onboarding Fee Policy
Apex Energy Service, LLC has implemented a New Hire Onboarding Fee. This Fee, which can be up to the maximum amount of $500.00, will ONLY be deducted from your last paycheck if you do not fulfill the Company's 90-day probation period.

If any employee resigns or is let go within 90 days of your new hire date, you may be subject to repaying the Fee. The Fee will be deducted from your last paycheck, not to exceed the $500.00 Maximum.

The Fee includes but is not limited to:
- New hire paperwork processing
- Pre-employment drug testing
- New hire orientations
- Additional safety courses on job site specific training
- Issued safety equipment
The applicant's signature below acknowledges that they agree to this Fee and the terms states above.
Signature*
Email
This field is for validation purposes and should be left unchanged.

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EMAIL ADDRESS *

PHONE NUMBER

SUBJECT

HOW CAN WE HELP?

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providing businesses, to a safer, cleaner, more
efficient and productive energy independent future."

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SERVICE AREAS

Pittsburgh, PA
Wheeling, WV
Cambridge, OH
Parkersburg, WV
Morgantown, WV

CONTACT US TODAY

HEADQUARTERS
3901 Washington Road
Suite 201
Canonsburg, PA 15317
855-301-APEX

info@apexservice.us

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