Your Name: Date of Birth:

Present Street Address: Zip Code:

Phone Number: Email Address:

Drivers License Number:

Are you a Legal US citizen? Yes: No:

Have you ever been convicted of a felony? Yes: No:

If yes, please explain:

Date you can start: Desired Pay: $

Are you currently employed? Yes: No:

If so, may we contact your employer? Yes: No:

Work Experience: please list your recent former employers

Start Date: End Date: Position:

Company Name: Company Address: Company Phone Number:

Reason For Leaving:

Start Date: End Date: Position:

Company Name: Company Address: Company Phone Number:

Reason For Leaving:

Start Date: End Date: Position:

Company Name: Company Address: Company Phone Number:

Reason For Leaving:

Education:

High School Name: City: Years Attended:

Did you graduate? Yes: No:

Subjects Studied:

College School Name: City: Years Attended:

Did you graduate? Yes: No:

Subjects Studied:

Other School Name: City: Years Attended:

Did you graduate? Yes: No:

Subjects Studied:

List or explain your skills that pertain to the position you are applying for:

Other Questions:

What are you passionate about?


What's a fun, random bit about yourself?


How can you contribute to the culture of GSI?


In what ways are you like or unlike your parents/guardians?


List 3 words to describe yourself:

References:

Please list three non-relative references below whom you have known for at least one year:

Name: Phone Number: Years Known:

How are you acquainted with this person?

Name: Phone Number: Years Known:

How are you acquainted with this person?

Name: Phone Number: Years Known:

How are you acquainted with this person?

By signing below and clicking submit, you authorize us to: Review your previous two years driving history and perform a preliminary background check. If you are selected for an interview, we will ask for your social security number as well as request you fill out an additional hard copy application as required by FMCSA and/or DOT regulations. I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from any liability for any damages that may result from such utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

Electronic Signature: