Employment Application

Kerns Trucking, Inc., in compliance with Federal and State equal employment opportunity laws, considers all applicants for all positions
without regard to race, color, sex, national origin, age, marital status, or the presence of a non-related medical condition or handicap.

Required fields marked with ( * )

Applicant Information

Last Name:*
First Name:*
Middle Name:
Date of Birth:*
Social Security #:*
Address:*
City/State/Zip:*
Phone:*
Email:*
Emergency Contact Name:
Emergency Contact Phone:


Applying for Position

 *


Owner/Operator Info

Truck (Year Make and Model) *
Trailer (Year Make and Model) *




Driving Experience

Class of EquipmentType of Equipment
(Dump, Van, Tank, Etc.)
No. of Years
Straight Truck:
Tractor/Trailer:



Have you ever been denied a license, permit or privilege to operate a motor vehicle? *
Has any License, permit or privilege ever been suspended or revoked? *
Have you ever tested positive or refused to test on any pre-employment drug test during the past 2 years? *
If you answered "Yes" to the above questions, please give details: *




Traffic convictions and forfeitures

(Last 3 Years - Other than parking violations)

(Instructions: Click the green "+" to add Traffic convictions. Click the red "X" to remove an item.)





Accident records

(Last 3 Years - Other than parking violations)

(Instructions: Click the green "+" to add Accident records. Click the red "X" to remove an item.)





Licenses and Qualifications

(Instructions: Click the green "+" to add Licenses. Click the red "X" to remove an item.)





Employment History (Last 5 Years)

(Instructions: Click the green "+" to add Past Employers. Click the red "X" to remove an item.)

Past Employer
* Required