Jobs   Jobs     More Information     Release


This online driver application will allow you to tell us some basic information about yourself. Please fill it out as completely as possible, and then press the "Send Application" button at the bottom of this page. You may also print out this application, and fax it to 816-421-4359.

This information will be forwarded to our driver recruiting department for processing.

All information will be held in the strictest confidence.

Personal Information
Full Name
Email Address
Street Address
City, State, Zip ,
Main Phone (Include Area Code)
Cell Phone/Other Phone1 (Include Area Code)
Pager/Other Phone2 (Include Area Code)
Birth Date
Social Security Number
How did you hear about Palmentere Brothers?
Position Applying For:
If Owner/Operator, Please List Make, Model, Year Of All Equipment You Have:
Date Available To Begin


Driving Experience
Driver's License Number
Driver's License State
Expiration Date
CDL? Yes  No
HAZMAT? Yes  No
Total Tickets In The Last 3 Years
Total Accidents In The Last 3 Years
Total DUI's


Has Your License Ever Been Suspended? Yes  No
If So, List When And Why It Was Suspended


Have You Ever Been Convicted Of A Crime? Yes  No
If So, List When, And Any Explanation


Employment History
Present Or Last Employer
Employer Name
Employer Address
Employer City, State, Zip ,
Employer Phone (Include Area Code)

Supervisor
Equipment Operated
Employed From (Month/Year)
Employed To (Month/Year)
Reason For Leaving
Second Last Employer
Employer Name
Employer Address
Employer City, State, Zip ,
Employer Phone (Include Area Code)

Supervisor
Equipment Operated
Employed From (Month/Year)
Employed To (Month/Year)
Reason For Leaving
Third Last Employer
Employer Name
Employer Address
Employer City, State, Zip ,
Employer Phone (Include Area Code)

Supervisor
Equipment Operated
Employed From (Month/Year)
Employed To (Month/Year)
Reason For Leaving
Fourth Last Employer
Employer Name
Employer Address
Employer City, State, Zip ,
Employer Phone (Include Area Code)

Supervisor
Equipment Operated
Employed From (Month/Year)
Employed To (Month/Year)
Reason For Leaving
Fifth Last Employer
Employer Name
Employer Address
Employer City, State, Zip ,
Employer Phone (Include Area Code)

Supervisor
Equipment Operated
Employed From (Month/Year)
Employed To (Month/Year)
Reason For Leaving
Sixth Last Employer
Employer Name
Employer Address
Employer City, State, Zip ,
Employer Phone (Include Area Code)

Supervisor
Equipment Operated
Employed From (Month/Year)
Employed To (Month/Year)
Reason For Leaving

 

Additional Comments:

 

AUTHORIZATION AND FORMAL RELEASE

I hereby authorize Palmentere Brother's Cartage Co. Inc and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment purposes. If hired, I understand that this authorization shall be effective throughout my employment, authorizing the Company to conduct comprehensive background checks at any time during my employment.

I hereby authorize Palmentere Brother's Cartage Co, Inc. to do a complete background investigation in accordance with state and federal laws. I authorize the release of any information, including all information related to my alcohol and controlled substances testing and training records conducted under the Federal Highway Administration (FHWA) 49 CFR Parts 40,382 or 391, by any former employers and hold them harmless of any liability from the release of said information.

I hereby authorize Palmentere Brother's Cartage Co., Inc. to conduct an investigation of my accident history for the past 3 years while employed in any position that is safety sensitive as defined by the DOT in Federal Motor Carrier Safety Regulations part 391, 390 and 382. I also authorize Palmentere Brother's Cartage Co., Inc. to perform an inquiry into my driving record for every state in which I have held a vehicle operator's license or permit in the last 3 years.

I understand that I have the right under FMCSR 391 and 390 to review information provided to Palmentere Brother's Cartage Co., Inc. by my previous employers. I also have the right to request that any errors in the provided information is corrected by my previous employer(s) and that the corrected information be resent to Palmentere Brother's Cartage Co., Inc. I have the right to have a written rebuttal statement attached to any erroneous information if my previous employer and myself cannot come to an agreement on the accuracy of any of the provided information.

I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: Verification of social security number, current and previous residences, employment history including all personnel files, education, character references, credit history and reports, criminal history records from any criminal justice agency in any or all federal, state or county jurisdictions, birth records, motor vehicle records to include traffic citations and registration and any other public records.

I authorize the complete release of these records or data pertaining to me which an individual, company, firm, corporation, or public agency may have. I understand that I must provide my date of birth to adequately complete said screening and acknowledge that my date of birth will not affect any hiring decisions.

I hereby release Palmentere Brother's Cartage Co., Inc. and its agents, officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may at any time, result to me, my heirs, family or associates because of compliance with this authorization and request to release. You may contact me as indicated above.

By submitting this application, I hereby certify that all information on this form is correct and complete to the best of my knowledge and that I have read and agree to the AUTHORIZATION AND FORMAL RELEASE above. You may also wish to print out and fax the release form into our office. The printable version can be found here.

I hereby authorize company(s) to obtain information concerning my past or current work history, and to do a complete background investigation. This may include but is not limited to ordering MVR, DAC Reports, etc.

I hereby release all such persons from any liabilities or damages.

ENTER YOUR FULL LEGAL NAME TO SERVE AS YOUR DIGITAL SIGNATURE: