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BRT’S/MLT INC.
1841 GOVER PARKWAY
MT. PLEASANT, MI  48858

APPLICATION FOR EMPLOYMENT

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or non-job related disabilities.

Date of application:        Position applied for:

Full Name(First Middle Last):        Social Security #:

Current address:    City:    State:    Zip:

Home Phone:        Cell Phone:

Driver's license#:        Drivers Lic. Endorsements:

Current E-mail Address:

Do you have the legal right to work in the United States?    CHOOSE ONE YES NO

Have you ever been convicted of an offense that would prevent you from entering Canada? ie: DUI, Narcotics, Domestic, etc    CHOOSE ONE YES NO

Do you have a current Passport?    CHOOSE ONE YES NO     You must possess  a passport to be eligible for employment.

Who referred you to our company?

Date of birth:(Required only for CDL applicants)

Do you have a current Medical Card?:    CHOOSE ONE YES NO         If (YES), Medical Card Expiration Date:

Have you been drug/alcohol tested in the last 6 months?:    CHOOSE ONE YES NO

Do you have tractor/trailer driving experience?:    CHOOSE ONE YES NO         If (YES), How many years driving experience?:

Do you have experience pulling a:    TANKER CHOOSE ONE YES NO         VANS CHOOSE ONE YES NO

Are you knowledgeable in log book regulations?:    CHOOSE ONE YES NO

EMPLOYMENT HISTORY

All driver applicants to drive interstate commerce must provide the following information on all employers during the previous 3 years.  List complete mailing address, street number, city, State, and zip code.

Applicants to drive a commercial motor vehicle*in interstate commerce shall also provide an additional seven years information on those employers for whom the applicant operated a interstate  vehicle.
(NOTE:  If additional space is needed, submit a 2nd application with only Employment History section completed.)

List employers in reverse order starting with the most recent. 

EMPLOYER:
ADDRESS:    CITY:    STATE:    ZIP:
EMPLOYED:    FROM (Month / Year)        TO (Month / Year)

EMPLOYER:
ADDRESS:    CITY:    STATE:    ZIP:
EMPLOYED:    FROM (Month / Year)        TO (Month / Year)

EMPLOYER:
ADDRESS:    CITY:    STATE:    ZIP:
EMPLOYED:    FROM (Month / Year)        TO (Month / Year)

EMPLOYER:
ADDRESS:    CITY:    STATE:    ZIP:
EMPLOYED:    FROM (Month / Year)        TO (Month / Year)

Addition Information you would like to add in your consideration for Employment: