We are an equal opportunity employer. Emerson is dedicated to a policy of non-discrimination in employment on any basis including race, creed, color, age, sex, religion or national origin, or handicap.

In order that your application may be properly evaluated, it is essential that all of the following questions be answered carefully and completely.
* required items
PERSONAL
Badge Number
Last Name*
First Name*
Middle Name
Today's Date* (mm/dd/yy)
Present Address
(Number & Street)*
City*
State*
Zip Code*
Previous Address
(Number & Street)*
City*
State*
Zip Code*
Telephone Number* (Home)
Social Security Number*
List current CDL #:   
Expiration Date:
Which endorsements?
State of Issue?

Location Applying For:
Job Applying For:
Years Experience Over the Road:* Years
Average Miles per Year: Miles
Type of Tractor:
Type Trailer:
Number of Vehicle Accidents:*

Are you employed now?*
If so, Why do You Want To Change?
Have You Previously Been Employed by this Company?* Yes No
If So, Please Give Dates. From    To  
EDUCATION
Grammar or High School
Years Completed:* Years
Degree Recd. & Major Sub.:*
Name of School:*
Location:*
Date of Graduation:* (mm/dd/yy)
Trade, Bus, or Correspondence
Years Completed: Years
Degree Recd. & Major Sub.:
Name of School:
Location:
Date of Graduation: (mm/dd/yy)
College
Years Completed: Years
Degree Recd. & Major Sub.:
Name of School:
Location:
Date of Graduation: (mm/dd/yy)
Other Training (Such As Truck Driving Courses, Haz Mat, Etc.)

EMPLOYMENT HISTORY
Record the past ten years of employment (Start with most recent or present employer)

Present Employer
Name of Present Employer
Phone
Date Employed:(mm/dd/yy) From: To:
Address of Employer
City:
State
Zip Code
Postition Title
Immediate Supervisor
(Name & Title)
Salary Start Finish
Reason For Leaving
Describe Your Responsibilities & Accomplishments
Previous Employer
Name of Previous Employer
Phone
Date Employed:(mm/dd/yy) From: To:
Address of Employer
City:
State
Zip Code
Postition Title
Immediate Supervisor
(Name & Title)
Salary Start Finish
Reason For Leaving
Describe Your Responsibilities & Accomplishments
Previous Employer
Name of Previous Employer
Phone
Date Employed:(mm/dd/yy) From: To:
Address of Employer
City:
State
Zip Code
Postition Title
Immediate Supervisor
(Name & Title)
Salary Start Finish
Reason For Leaving
Describe Your Responsibilities & Accomplishments
Previous Employer
Name of Previous Employer
Phone
Date Employed:(mm/dd/yy) From: To:
Address of Employer
City:
State
Zip Code
Postition Title
Immediate Supervisor
(Name & Title)
Salary Start Finish
Reason For Leaving
Describe Your Responsibilities & Accomplishments
Previous Employer
Name of Previous Employer
Phone
Date Employed:(mm/dd/yy) From: To:
Address of Employer
City:
State
Zip Code
Postition Title
Immediate Supervisor
(Name & Title)
Salary Start Finish
Reason For Leaving
Describe Your Responsibilities & Accomplishments
Previous Employer
Name of Previous Employer
Phone
Date Employed:(mm/dd/yy) From: To:
Address of Employer
City:
State
Zip Code
Postition Title
Immediate Supervisor
(Name & Title)
Salary Start Finish
Reason For Leaving
Describe Your Responsibilities & Accomplishments
Military Service (If None, write "NONE")
Dates of Active Duty: From     Until
Are you currently a member of the reserves* Yes    No
If Yes Active    Inactive
Have you ever been discharged from a job?*
Explain:
Have you ever been convicted of a crime other than violation of motor vehicle laws or ordinances?*
Give Details:
Has any license or permit to operate any motor vehicle to you ever been suspended or revoked?*
Give Details:
References
Please list References, Indicate Relationship to you, such as Superior, Co-Worker, Personal, ETC.
First Personal Reference
Name (Last, First, Middle)*
Telephone Number*
Address(Number & Street)*
City*
State*
Zip Code*
Relationship*
Position
Years Known*
Second Personal Reference
Name (Last, First, Middle)
Telephone Number
Address(Number & Street)
City
State
Zip Code
Relationship
Position
Years Known
Third Personal Reference
Name (Last, First, Middle)
Telephone Number
Address(Number & Street)
City
State
Zip Code
Relationship
Position
Years Known
Fourth Personal Reference
Name (Last, First, Middle)
Telephone Number
Address(Number & Street)
City
State
Zip Code
Relationship
Position
Years Known
Fifth Personal Reference
Name (Last, First, Middle)
Telephone Number
Address(Number & Street)
City
State
Zip Code
Relationship
Position
Years Known
List all Vehicle Accidents Involved in During the Past Three Years. (If None, Write "None")
Accident #1
Nature of Accident
Date
Any Injury or Fatalities?
Accident #1
Nature of Accident
Date
Any Injury or Fatalities?
Accident #3
Nature of Accident
Date
Any Injury or Fatalities?
List all Violations of Motor Vehicle Laws or Ordinances (Other than Parking) for which you were Convicted or Forfeited Bond or Collateral for Last Three Years. (If None, Write "None")
Additional Information
In Case of Emergency Notify
Name (Last, First, Middle)*
Relationship*
Telephone Number*
Name of Wife (or Husband)
Social Security #
Occupation*
Company
Pre-Employment Voluntary Self-Identification
Our organization is committed to the employment and advancement of qualified minorities and females.
If you fall into one or more of these classifications, we invite you to identify yourself.

We are gathering the following information, not for employment decisions, but for record keeping in compliance with federal regulations. This information will be kept separate from your Employment Application. Your responses are strictly voluntary and will help in developing and monitoring our affirmative action programs.

Information provided will be kept in the strictest confidence. However, if you choose not to respond, this will not affect the decision regarding your employment opportunity.
Sex Male Female
Race White, not Hispanic or Latino
Black/African American, not Hispanic or Latino
Hispanic or Latino
American Indian or Alaskan Native, not Hispanic or Latino
Asian, not Hispanic or Latino
Native Hawaiian or Other Pacific Islander, not Hispanic or Latino
Two or more races, not Hispanic or Latino
Where did you learn of this job opportunity Newspaper
Local Job Service
Emerson Driver
Internet
Friend
School/Agency Referral
Please read carefully before submitting this Application.
Important
This certifies that this application and all entries on it and information in it are true and complete to the best of my knowledge.
I hereby authorize my former employers or references to furnish any information concerning my personal character, habits or employment record and I hereby release all such persons from any liability or damages on account of having furnished this information.
I hereby agree that I am employed on a six (6) month's probationary basis. I understand that should I be employed and later laid off, that at the end of a one (1) year lay off, I am permanently laid off.
I hereby agree to submit to a physical examination and drug screening as requested by Emerson Electric - Transportation Division and required by State and Federal rules and regulations.
If employed, I agree to abide by all present and subsequently issued policies, rules and regulations of Emerson Electric - Transportation Division.
It is understood and agreed to that my employment is at will and for no definite period and may, regardless of the period of payment of my wages/salary, be terminated at any time for any reason without previous notice. I further understand that no Emerson Electric - Transportation Division official has made, or has the authority to make, any promises to the contrary and I have not been guaranteed employment for any special period of time.
This use of this application form does not indicate that there any positions available, and in no way obligates Emerson Electric - Transportation Division.