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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:

 

By submitting this application, I hereby certify that all information on this form is correct and complete to the best of my knowledge.

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.