* indicates required field

Full Name*

Social Security Number*

Current Address*(Street, City, State, Zip)

Years lived at Current Address?*

Is this less then 3 years?*
YesNo

Phone Number*

Alt Phone Number

Are you at least 18?*
YesNo

Can you be legally be employed in the USA?*
YesNo

Email Address*

Position Applying For*

Shop/Location Preference #1*

Shop/Location Preference #2

Rate of pay requested?*

What shift(s) can you work?*

How did you hear about us/referred by*

When are you available to start?*

Are you willing to relocate?
YesNo

Have you worked with us in the past?
YesNo

Have you even been convicted of a felony?*
YesNo

Education:
Check All That Apply:
High SchoolCollegeTrade School

Military Service:
Have you served in the Military?
YesNo

Driver's License/Motor Vehicle Record:

Driver's License Issuing State?*

Driver's License Number* (Within the last 3 years)

Do you have a Motor Vehicle Record to add?
YesNo

Accidents:
Have you had any accidents in the last 3 years?
YesNo

Traffic Convictions:
Have you had any traffic convictions and forfeitures for the
last 3 years? Other than parking violations?
YesNo

Have you even been denied a license to operate a motor vehicle
in the last 3 years?
YesNo

Has any Licence, permit or privilege even been suspended,
restricted, or revoked?
YesNo

Are you Ref/Recovery Certified?
YesNo

Are you certified to do DOT inspections?
YesNo

Do you have any ASE Certifications?
YesNo

Experience:

Please Indicate the years/months of formal training and/or
experience with the following:(e.g 1y6m)

Drive Line Components
TrainingExperience

Diesel engine tune-up and re-build
TrainingExperience

Engine Rebuilding?
TrainingExperience

Brakes/ABS
TrainingExperience

Transmission
TrainingExperience

Body Work/Repair
TrainingExperience

Sheet Metal Equipment
TrainingExperience

Frame and Axle Straitening Equipment
TrainingExperience

Alignment
TrainingExperience

PM's
TrainingExperience

Welding (please note type)
TrainingExperience

Electronics
TrainingExperience

Electrical
TrainingExperience

Electronic Diagnostic Equipment
TrainingExperience

A/C
TrainingExperience

Wheel Seals
TrainingExperience

5th Wheel
TrainingExperience

Wheel and Tire Balancing Machine
TrainingExperience

Diagnostic Tools
TrainingExperience

Hand Tools
TrainingExperience

Trailer Body Repair
TrainingExperience

Lift Gate Repair
TrainingExperience

Please list any other skills, training, or experience that you would like us to know about

For your current/most recent employer

Name and Address

Telephone

Supervisor

Position Held

Dates of Employment

Rate of Pay

Reason for leaving

Duties

Do you have another past employer to add?
YesNo

I certify that I have read and understood all of this employment application. It is agreed and understood that the employer or his agents may investigate my background to ascertain any and all information of concern to my employment history, whether same is if record or not, and I release employers and other person named herein from all liability for any damages on account of furnishing such information. I understand that, as an applicant that if offered a position, it may be conditioned on the results of a physical examination and drug test. I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment with the employer and for no other reason. (Initial)

I agree that any claim or lawsuit relating to my service with Kirk Nationalease Co. or any of its subsidiaries must be filed no more than 6 months after the date of the employment action that is the subject of the claim or lawsuit. I expressly agree to waive any statue of limitations to the contrary. I understand that if I become an employee of Kirk Nationalease Co., or it's subsidiaries or affiliates, at any time in the future, this application of employment will become a part of my official employment record. I further acknowledge that Kirk Nationalease Co. will be relying on the information contained in this application in any hiring decisions and that I am contractually bound by the terms contained herein. (Initial)

I also understand that misrepresentation or omission of information or facts may result in my dismissal. If hired I agree to abide by all company rules. By signing below, I acknowledge that this application was completed be me, and that all entries are true and completed to the best of my knowledge. (Initial)

Date:

Sign:

Kirk NationaLease, Co (the "Company") may request from a consumer reporting agency and for employment-related purposes, a "consumer report(s)" (commonly known as "background reports") containing background information about you in connection with your employment, or application for employment, or engagement for services (including independent contractor or volunteer assignments, as applicable).

HireRight, LLC ("HireRight") will prepare or assemble the background reports for the Company. HireRight is located and can be contacted at 3349 Michelson Drive, Suite 150, Irvine, CA 92612, (800) 400-2761, www.hireright.com.

The background report(s) may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing. The types of background information that may be obtained include, but are not limited to: criminal history; litigation history; motor vehicle record and accident history; social security number verification; address and alias history; credit history; verification of your education, employment and earnings history; professional licensing, credential and certification checks; drug/alcohol testing results and history; military service; and other information.

Investigative Consumer Report:

Kirk NationaLease Co (the "Company") may request an investigative consumer report about you from HireRight, LLC ("HireRight"), a consumer reporting agency, in connection with your employment, or application for employment, or engagement for services (including independent contractor or volunteer assignments, as applicable). An "investigative consumer report" is a background report that includes information from personal interviews ( except in California, where that term includes background reports with or without information obtained from personal interviews), the most common form of which is checking personal or professional references through personal interviews with sources such as your former employers and associates, and other information sources. The investigative consumer report may contain information concerning your character, general reputation, personal characteristics, mode ofliving, or credit standing. You may request more information about the nature and scope of an investigative consumer report, if any, by contacting the Company.

If the Company hires you or contracts for your services, the Company may obtain additional consumer reports and investigative consumer reports about you without asking for your authorization again, throughout your employment or your contract period, as allowed by law.

HireRight Privacy Policy:

Information about HireRight's privacy practices is available at www.hireright.com/Privacy-Policy.aspx.

I acknowledge that I have received and carefully read and understand the separate "Disclosure and Authorization Regarding Background Investigation for Employment Purposes that has been provided to me by the Company.

By my signature below, I authorize the preparation of background reports about me, including background reports that are "investigative consumer reports" by HireRight, and to the furnishing of such background reports to the Company and its designated representatives and agents, for the purpose of assisting the Company in making a determination as to my eligibility for employment or engagement for services (including independent contractor or volunteer assignments, as applicable), promotion, retention or for other lawful employment purposes. I understand that if the Company hires me or contracts for my services, my consent will apply, and the Company may, as allowed by law, obtain from HireRight (or similar consumer reporting agency other than HireRight) additional background reports pertaining to me, without asking for my authorization again, throughout my employment or contract period.
I understand that if the Company obtains a credit report about me, then it will only do so where such information is substantially related to the duties and responsibilities of the position in which I am engaged or for which I am being evaluated.

I understand that information contained in my employment ( or contractor or volunteer) application, or otherwise disclosed by me before or during my employment ( or contract or volunteer assignment), if any, may be used for the purpose of obtaining and evaluating background reports on me. I also understand that nothing herein shall be construed as an offer of employment or contract for services.

I understand that the information included in the background reports may be obtained from private and public record sources, including without limitation and as appropriate: government agencies and courthouses; educational institutions; and employers. Accordingly, I hereby authorize all of the following, to disclose information about me to the consumer reporting agency and its agents: law enforcement and all other federal, state and local government agencies and courts; educational institutions (public or private); testing agencies; information service bureaus; credit bureaus and other consumer reporting agencies; other public and private record/data repositories; motor vehicle records agencies; my employers; the military; and all other individuals and sources with any information about or concerning me. The information that can be disclosed to the consumer reporting agency and its agents includes, but is not limited to, information concerning my: employment and earnings history; education, credit, motor vehicle and accident history; drug/alcohol testing results and history; criminal history; litigation history; military service; professional licenses, credentials and certifications; social security number verification; address and alias history; and other information. I hereby release any and all individuals connected with obtaining or providing such information from any and all liability for acts arising out of or pertaining to the provision of such information.

By my signature below, I also promise that the personal information I provide with this form or otherwise in connection with my background investigation is true, accurate and complete, and I understand that dishonesty or material omission may disqualify me from consideration for employment. I further understand that I have the right to request further disclosures regarding the nature and scope of the report(s) solicited by the Company and, upon my request to the Company, to receive a written summary of my legal rights as they pertain to such reports. I agree that a copy of this document in faxed, photocopied or electronic (including electronically signed) form will be valid like the signed original.

Applicant Last Name

First

Middle

Date:

Sign:

I, ___ (CDL Holder Name), hereby provide consent to
KIRK NATIONALEASE, CO. to conduct a limited query of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse (the “Clearinghouse”) to determine whether drug or alcohol violation information about me exists in the Clearinghouse. If KIRK NATIONALEASE, CO. hires me, KIRK NATIONALEASE, CO. may conduct unlimited additional limited queries of the Clearinghouse for the duration of my employment.

I understand that the limited query conducted by KIRK NATIONALEASE, CO. indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to KIRK NATIONALEASE, CO. without first obtaining additional specific consent from me.

I further understand that if I refuse to provide consent for KIRK NATIONALEASE, CO. to conduct a limited query of the Clearinghouse, KIRK NATIONALEASE, CO. must prohibit me from performing safety-sensitive functions, including driving a commercial vehicle, as requested by FMCSA’s drug and alcohol program regulations.

Sign:

Date: