A KANE FAMILY COMPANY
2300 T Street N.E. • Washington, DC 20002
Driver’s Application for Employment
Position(s) applied for
Date of Application
Referral Source
Last
Address:
Telephone # (
First
Street
Middle
Social Security #
City-State-Zip Code
)
Cell Phone # (
Date of Birth (Required for Commercial Drivers by U.S. DOT 391.21(b)(2)
)
/
Relative
Internet
Government Employment Agency
Advertisement
Employee
Walk - in
Private Employment Agency
Name of source (if applicable)
Name:
/
E-mail Address
/
/
Can you provide proof of age?
........
...............................................
May we contact you at work? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If yes, work number and best time to .call
........................( )
Have you submitted an application here before? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
If necessary, best time to call you at home is
No
:
Yes
AM
PM
No
:
Yes
AM
PM
No
If yes, give date(s) and position(s)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
If yes, give dates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . From
/
/
To
/
/
Are you able, with or without reasonable accommodations, to perform the essential job functions? . . . . . . . . . . . . Yes
Are you legally eligible for employment in the U.S.? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
Date available for work . . . . . . . . . . . . .
/
/
What is your desired salary?. . . . . . . . . . . . . . . . $
Have you ever been employed here before?
Type of employment desired
Full-Time
No
No
No
Part-Time
Driver’s License number
State
Have you ever been convicted of a crime? (Please only list convictions not charges for which there was no resulting conviction). . . . . . . . .
Yes
If yes, please provide date(s) and details
No
Answering “Yes” to these questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, and rehabilitation
applied for will be taken into account.
List your addresses of residency for the past 3 years.
Current Address:
Previous Addresses:
Street
State
City
Zip
Phone
How Long?
Street
City, State, Zip
How Long?
Street
City, State, Zip
How Long?
Street
City, State, Zip
How Long?
Street
City, State, Zip
How Long?
INTERNATIONAL LIMOUSINE SERVICE, INC. IS AN EQUAL OPPORTUNITY EMPLOYER AND SELECTS INDIVIDUALS BEST MATCHED FOR THE JOB BASED UPON JOB RELATED
QUALIFICATIONS REGARDLESS OF AGE, RACE, COLOR, SEX, RELIGION, NATIONAL ORIGIN, DISABILITY (PHYSICAL OR MENTAL), OR MARITAL STATUS. ILS IS A VEVRAA
FEDERAL CONTRACTOR AND AN EQUAL OPPORTUNITY EMPLOYER OF INDIVIDUALS WITH DISABILITIES AND OF PROTECTED VETERANS.
Employment History
List all accidents for the past 3 years or more (attach sheet if more space is needed). If none, write none.
DATES
TYPE OF VEHICLE
NATURE OF ACCIDENT
FATALITIES
HEAD-ON, REAR-END, UPSET, ETC.
(EXPLAIN)
Yes
MOST RECENT
NEXT RECENT
NEXT RECENT
INJURIES
(EXPLAIN)
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Traffic conviction and forfeitures for the past 3 years (other than only parking violations). If none, write none.
LOCATION
DATE
CHARGE
PENALTY
(ATTACH SHEET IF MORE SPACE IS NEEDED)
Educational Background
CIRCLE HIGHEST LEVEL COMPLETED:
LAST SCHOOL ATTENDED
1 2 3 4 5 6 7 8
(NAME)
HIGH SCHOOL: 1 2 3 4
(CITY)
COLLEGE:
1 2 3 4
(STATE)
Experience and Qualifications - Driver
DATES
LICENSE NO.
TYPE
ENDORSEMENTS EXPIRATION DATE
ALL DRIVERS
LICENSES
HELD IN
PREVIOUS
3 YEARS
A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?
B. Has any license, permit, or privilege ever been suspended or revoked?
C. Have you ever been disqualified for violations of the Federal Motor Carrier Safety Association
(If you answered “Yes” to any above, attach statement giving details.)
Yes
Yes
Yes
No
No
No
Driving Experience - If none, write none.
CLASS OF EQUIPMENT
TYPE OF EQUIPMENT
(VAN, TANK, FLAT, ETC.)
FROM
DATES
TO
Straight Truck
Tractor and Semi-Trailer
Tractor - Two Trailers
Passenger Vehicle
Other
LIST STATES OPERATED IN FOR LAST FIVE YEARS
LIST SPECIAL COURSES OR TRAINING THAT WILL HELP YOU AS A DRIVER
WHICH SAFE DRIVING AWARDS DO YOU HOLD AND FROM WHOM?
AREAS
TRAVELED
APPROX. NO OF MILES
PLEASE READ CAREFULLY BEFORE SIGNING
EMPLOYMENT APPLICATION AND AGREEMENT
I understand that completion of this application does not indicate that there are any positions open and does not in any way obligate the
Company to hire me or to offer me a job. I also understand this application is current for only thirty (30) days. If I have not been contacted
within thirty (30) days and still wish to be considered for employment, I must fill out a new application.
I understand that if hired, my employment with the Company would be for an indefinite period of time and may be terminated by me or the
Company at any time for any or no reason. Likewise, no oral statements or assurances by any person within the Company will constitute an
employment contract which can only be entered into by an individualized written agreement signed by me and an officer of the Company.
I agree that, if I am hired, I will conform with all company policies and procedures and understand that the Company may modify, amend,
and/or revoke and of its employment policies, practices, and benefits without prior written notice or my consent. Furthermore, I agree that,
if I am hired, the Company shall have the right to withhold all or part of my wages to offset any financial liability I may have to the
Company, including loss of product through theft, carelessness or negligence.
I understand that if I am hired, I will be a probationary employee during the 90-day introductory period and that after completion of my
probation period, I understand that the relationship shall continue to be an employment at-will relationship, terminable at any time with or
without cause or reason by either me or the Company.
I understand that the company has a policy that provides for a drug and alcohol free work place and that I must not test positive for controlled
substances or alcohol as a condition of employment or continued employment. I hereby consent to the submission of my urine specimen to
the certified laboratory designated by the Company, to the analysis of the specimen for controlled substances and alcohol, and to the release
of the test results from that analysis to the Medical Review Officer designated by the Company. I hereby release the clinics, testing
laboratories and the company and any employees and/or agents thereof, from any and all claims or causes of action resulting from the
collection and or testing procedures and from disclosure of these results. I hereby further agree to waive any physician/patient privileges
that may otherwise exist with respect to the confidentiality of the results of such testing. I further understand that I am subject to drug and
alcohol testing as a condition of ongoing employment and my failing to consent to the procedures to perform such testing when applicable
will be regarded as a positive test result and will result in my termination from employment.
I understand that if I am hired, I may be required at any time to submit to a drug test, alcohol test, and/or medical examination, to the extent
permitted by law, conducted by a licensed physician selected by the Company at Company expense. I hereby give a continuing authorization
to any hospital or other health care facility and to any physician or other person conducting such medical examinations and/or test to furnish
the Company or its designated agent, any medical records or medical information as may be relevant and necessary including testifying at a
deposition or otherwise cooperating in the investigation of any claim against the Company or the insurance carriers of the Company,
including any claim I may have for workman’s compensation.
I understand that the Company reserves the right to use any method of investigation which, in its sole discretion, it deems reasonable and
necessary to determine whether any employee has engaged in conduct warranting disciplinary action. As a condition of employment, if
hired, I agree to cooperate in any such investigation. As a condition of my employment, I voluntarily agree to cooperate in submitting to
any urine or blood tests requested by the Company, as well as any searches of my person or property while employed by the Company, and
I recognize that refusal to cooperate in such tests or searches would be grounds for discipline, including termination.
****Authorization to obtain consumer report****
I certify that I have received a written notification that the Company may obtain a consumer report on me. This report may be used in
connection with my application for employment and for other employment related purposes, including post-employment issues. I authorize
the Company to obtain this report.
I understand that the Company may investigate my work and personal history. I authorize all person, schools, companies, corporations, credit
bureaus and law enforcement agencies to supply any information concerning my background and release them from any liability and responsibility
from their doing so. I also authorize the Company to provide truthful information concerning my employment with the Company to future
prospective employers and I agree to hold the Company and its employees harmless for providing such information.Federal law prohibits the
employment of unauthorized aliens. If hired, I agree to comply with the law by signing all required forms and by submitting satisfactory
proof of employment authorization and identity within three (3) days of being hired. Failure to do so will result in immediate termination.
For Maryland applicants only: Under Maryland law, an employer may not require or demand any applicant for employment or prospective
employment or any employee to submit to or take polygraph, lie detector or similar test or examination for employment or continued
employment. Any employer who violates this provision is guilty of a misdemeanor and subject to a fine not to exceed $100.00.
SIGNATURE OF APPLICANT
DATE
I certify that I have read and understand the above paragraphs. I further certify that all information submitted on this application is true and
correct to the best of my knowledge. I understand that any false information, omission, or misrepresentations of facts called for in this
application or in interviews may be cause for the denial of my application or, if I am employed, discharged at any time. I also affirm that I
have a genuine intent and no other purpose in applying for a position with the Company.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENTS AND AGREEMENTS.
PRINT NAME
SIGNATURE OF APPLICANT
DATE
Affirmative Action
Voluntary Information
We consider all applicants for positions without regard to race, color, religion, sex, national origin, citizenship, age, mental or physical
disabilities, veteran/reserve/national guard or any other similarly protected status. We also comply with all applicable laws governing
employment practices and do not discriminate on the basis of any unlawful criteria.
To be completed by applicant on a voluntary basis. Not for interview purposes. To be filed separately from application.
In an effort to comply with requirements regarding government record keeping, reporting and other legal obligations which may
apply, we invite you to complete this applicant data survey. Providing this information is STRICTLY VOLUNTARY. Failure to
provide it will not subject you to any adverse personnel decision or action. Your cooperation is appreciated.
Please be advised that this survey is not a part of your official application for employment. It will not be used in any hiring decision.
The information will be used and kept confidential in accordance with applicable laws and regulations.
PLEASE PRINT
Position(s) applied for
Date
Referral Source
Walk-in
Employee
Advertisement - Source
Government Employment Agency
Relative
/
/
Private Employment Agency
School
Other
Name of person who referred you (If applicable)
Applicant Information
Name
Last
Address
Male
First
Middle
Street
City
Telephone # (
)
State
Zip Code
Female
Please check one of the following Equal Employment Opportunity Identification Groups:
White (not of Hispanic origin)
Asian/Pacific Islander
Disabled
American Indian/ Alaskan Native
Hispanic
Veteran
Black (not of Hispanic origin)
Multiracial (having parents of different races)
Protected Veteran
For Administrative Use Only
Position(s) applied for
Available
Not Available
Other positions considered for
Hired
Yes
No
Position hired for
Date of hire
/
/
From the EEO job classifications listed below, which one best describes the position filled?
Officials
Professionals
Technicians
Sales Workers
Office and Clerical Workers
Craft Workers (skilled)
Operatives (semi-skilled)
Laborers (unskilled)
Service Workers
Notes
Completed by
Date
/
/
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A KANE FAMILY COMPANY
2300 T Street N.E. • Washington, DC 20002
NOTICE AND AUTHORIZATION
Concerning Consumer and Investigative Consumer Reports
This form, which you should read carefully, has been provided to you because our Company may request consumer reports or investigative
consumer reports in connection with your application for employment, or at any time during the course of your employment with the Company,
if any, for purposes of evaluating your suitability for employment, promotion, reassignment or retention as an employee. Additionally, in the
event that claims or disputes between you and the Company are filed with any third parties, the Company may request consumer reports or
investigative consumer reports for purposes of evaluation and response, regardless of whether you remain in the employ of the Company at the
time such claims or disputes arise.
The types of reports that may be requested from consumer reporting agencies under this policy include, but are not limited to, credit reports,
criminal records checks, court records checks, driving records, and/or summaries of educational and employment records and histories. The
information contained in these reports may be obtained by a consumer reporting agency from public record sources or through personal
interviews with your coworkers, neighbors, friends, associates, current or former employers, or other personal acquaintances.
I understand that the Company may investigate my work and personal history. I authorize all person, schools, companies, corporations, credit
bureaus and law enforcement agencies to supply any information concerning my background and release them from any liability and
responsibility from their doing so. I also authorize the Company to provide truthful information concerning my employment with the Company
to future prospective employers and I agree to hold the Company and its employees harmless for providing such information.
AUTHORIZATION
I have carefully read and understand this notice and authorization form and, by my signature below, consent to the release of consumer or
investigative consumer reports, as defined above, to the Company (1) in conjunction with my application for employment, (2) during the entire
course of my employment, if any, and (3), after any such employment ends. I further understand that any and all information contained in my
job application or otherwise disclosed to the Company by me before, during or after my employment, if any, may be utilized for the purpose of
obtaining the consumer reports or investigative consumer reports requested by the Company and confirm that all such information provided in
connection with my job application is true and correct. I understand and acknowledge that nothing in this notice and authorization is intended
to be, or is, an offer of employment or a promise of continued employment. If employed by the Company, my employment will not be for a
specified period of time and can be terminated at any time for any reason, with or without cause or notice, by me or by the Company.
The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40
years of age. I understand that my date of birth is required by some governmental agencies as a prerequisite in releasing the requested
information to the Company and/or its designated agent and that my date of birth will not be used in any other way in the employment process
other than the release of the information as described above.
Full Name (no nicknames):
S.S.N.:
Other names previously used and when (maiden names, nicknames, etc.):
Date of Birth:
Driver’s License Number
State:
Have you ever been convicted of a crime? (Please only list convictions not charges for which there was no resulting conviction) Yes
No
If yes, give details:
ADDRESS
Street
City
County State
Zip Code
Current:
Previous:
Previous:
Previous:
Applicant Signature:
Date:
From
To
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A KANE FAMILY COMPANY
2300 T Street N.E. • Washington, DC 20002
DRUG AND ALCOHOL
Consent and Release Policy
Having been advised that International Limousine Service, Inc. has a policy that provides for a drug and alcohol
free work place, I understand that I must not test positive for controlled substances as a condition of employment
or as a condition of providing leased driving services. I hereby consent to the submission of my urine specimen
to the certified laboratory designated by the Company, to the analysis of the specimen for controlled substances
as provided by federal requirements, and to the release of the test results from that analysis to the Medical Review
Officer designated by the Company.
Additionally, in accordance with DOT regulations and company policy, I understand that I may be subject to drug
and alcohol testing as a condition of on-going employment or as a condition of leased driving services, and hereby
consent to the procedures to perform such testing when applicable. I understand that I may request, at my expense,
to have a specimen retested.
Further, I hereby release the clinics, testing laboratories and International Limousine Services, Inc. and any
employees and/or agents thereof, from any and all claims or causes of action resulting from the collection and/or
testing procedures and from disclosure of these results. I hereby further agree to waive any physician/patient
privilege that may otherwise exist with respect to the confidentiality of the results of such testing.
Printed Name:
Signed:
Date:
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A KANE FAMILY COMPANY
2300 T Street N.E. • Washington, DC 20002
APPLICANT’S NOTES
INTERVIEWER’S COMMENTS
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