Owner: Steve Mox

Phone: (574) 389-9195   









    Only for applicants who are applying for a safety-sensitive position in compliance with U.S. Department of Transportation 49CFR391.21. 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, mental status, or non-job related disability.

Position(s) Applied For:   Date:

Name (First, Middle, Last):   SS#:

Address, Street:   City:   State:   Zip:

Need Address for Previous Three Years:

Street:   City:   State:   Zip:

Date of Birth:   Can you provide proof of age:

Is there any reason you might be unable to perform the functions of the job for which you have applied:

If yes, please explain:

Have you ever filed an application with us before:   If yes, give date:

Have you ever been employed with us before:   If yes, give date:

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment):

On what date would you be available for work:

Are you available to work Full Time, Part Time or Temporary:   Hours Available:

Are you currently on "layoff" status and subject to recall:

Have you ever been convicted of, or admitted guilt (including suspended, expunged, and/or deferred sentences) to, any crime involving dishonesty or breach of trust:

If yes, please explain: