Select a Recruiter's NameBrandi NortonTim Oberstein
Select From BelowCompany DriverOwner Operator
Have You Ever Been Convicted of a Crime? NoYes
Was Your License Ever Suspended or Revoked? NoYes
Have You Tested Positive On a Drug/Alcohol Test in the Last 3 Years? NoYes
Number of Accidents Involved
Number of Preventable Accidents
Number of Roll-Over Accidents
Number of Tickets Received
Number of Reckless Tickets
How Many Jobs Have You Had in the Last 3 Years?
Have You Ever Applied or Worked for R.B.I Before? NoYes
When Will You Be Available for Employment?
Dates Employed: From to
Past Employer (1)
Past Employer (2)
Past Employer (3)
This certifies that this application was completed by me, and that all entries on it and information on it are true and complete to the best of my knowledge. I hereby request and authorize Robert Bearden, Inc. and their agents or contractors that receive this application to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but it is not limited to, any information relating to my character, general reputation, personal characteristics, mode of living, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have associated parties for the use of this application. As part of our consideration of your application, the DOT requires companies to investigate your employment background. As part of this investigation, they may obtain consumer reports about you from various consumer reporting agencies including USIS(DAC) and PSP Reports. Any decision they make not to hire you based on information contained in your consumer report will be their decision alone. DAC does not make any decisions concerning your employment with these companies and will not know the specific reasons why they may decide not to hire you. In the event you are not hired based on information contained in your consumer report, the companies themselves will tell you. We will also advise you of your right to obtain a free copy of the consumer report from DAC and your right to dispute the accuracy or completeness of your report. Your consent for these companies to obtain the report from DAC is required. Although you have a right to withhold your consent, companies will not consider your application if you withhold your consent.
I have read and agree to the above release and I give my permission to obtain consumer reports about me. ...NoYes