Work with Us

Name(Required)

First Middle Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Email(Required)

Phone(Required)

Position desired?(Required)

Availability(Required)

Full-time

Part-time

Any

What date are you available to begin work?(Required)

Salary desired?(Required)

Are you legally eligible to be employed in the United States?(Required)

Yes

No

(Proof of identity and eligibility will be required upon employment)

Are you over the age of 18 years?(Required)

Yes

No

If no, what is your age(Required)

Have you ever worked for our organization before?(Required)

Yes

No

Do you have any relatives or friends who work for the company?(Required)

Yes

No

If yes, where?(Required)

When? (Give dates)(Required)

Job Title?(Required)

If yes, who and where do they work?(Required)

Have you ever done any volunteer work?(Required)

Yes

No

How did you hear about this opening?(Required)

If yes, describe; and include any volunteer work for our organization:(Required)

Are you willing to take drug tests as required for employment at our organization?(Required)

Yes

No

We drug test for pre-employment, suspicion, post-accident and random monthly.

Employees are required to be flexible with their work schedule including weekends, early mornings, late evenings, working overtime or extra shifts as business needs require without any notice.

Are you able to work whatever hours we assign you?(Required)

Yes

No

Are you able to have predictable attendance at work?(Required)

Yes

No

Do you understand the importance of a safe workplace?(Required)

Yes

No

EDUCATION

High School

Name and Location of School(Required)

Course of Study(Required)

Diploma or Degree Received(Required)

No. of Years Completed(Required)

College

Name and Location of School

Course of Study

Diploma or Degree Received

No. of Years Completed

Vocational or Trade School

Name and Location of School

Course of Study

Diploma or Degree Received

No. of Years Completed

Have you completed any special courses, seminars and/or training directly related to the position for which you are applying?(Required)

Yes

No

EMPLOYMENT

Start with your current or most recent position and provide your last 10 years of employment. You are required to list the complete address.

May we contact your current employer?(Required)

Yes

No

#1 Employer

Name(Required)

Position Held(Required)

Full Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Supervisor's Name(Required)

First

Title(Required)

Phone(Required)

Dates Employed From - To:(Required)

Describe the Work Performed(Required)

Reason for Leaving(Required)

Account for period between jobs – include month/year and reason:(Required)

Were you subject to the Federal Motor Carrier Safety Regulations while employed?(Required)

Yes

No

Was your job designated as a safety-sensitive function in a DOT regulated mode subjected to the drug and alcohol testing requirements of 49 CFR Part 40?(Required)

Yes

No

Type of vehicle driven(Required)

Approximate mileage driven(Required)

#2 Employer

Name

Position Held

Full Address

Street Address City State / Province / Region ZIP / Postal Code Country

Supervisor's Name

First

Title

Phone

Dates Employed From - To:

Describe the Work Performed

Reason for Leaving

Account for period between jobs – include month/year and reason:

Were you subject to the Federal Motor Carrier Safety Regulations while employed?

Yes

No

Was your job designated as a safety-sensitive function in a DOT regulated mode subjected to the drug and alcohol testing requirements of 49 CFR Part 40?

Yes

No

Type of vehicle driven

Approximate mileage driven

#3 Employer

Name

Position Held

Full Address

Street Address City State / Province / Region ZIP / Postal Code Country

Supervisor's Name

First

Title

Phone

Dates Employed From - To:

Describe the Work Performed

Reason for Leaving

Account for period between jobs – include month/year and reason:

Were you subject to the Federal Motor Carrier Safety Regulations while employed?

Yes

No

Was your job designated as a safety-sensitive function in a DOT regulated mode subjected to the drug and alcohol testing requirements of 49 CFR Part 40?

Yes

No

Type of vehicle driven

Approximate mileage driven

#4 Employer

Name

Position Held

Full Address

Street Address City State / Province / Region ZIP / Postal Code Country

Supervisor's Name

First

Title

Phone

Dates Employed From - To:

Describe the Work Performed

Reason for Leaving

Account for period between jobs – include month/year and reason:

Were you subject to the Federal Motor Carrier Safety Regulations while employed?

Yes

No

Was your job designated as a safety-sensitive function in a DOT regulated mode subjected to the drug and alcohol testing requirements of 49 CFR Part 40?

Yes

No

Type of vehicle driven

Approximate mileage driven

#5 Employer

Name

Position Held

Full Address

Street Address City State / Province / Region ZIP / Postal Code Country

Supervisor's Name

First

Title

Phone

Dates Employed From - To:

Describe the Work Performed

Reason for Leaving

Account for period between jobs – include month/year and reason:

Were you subject to the Federal Motor Carrier Safety Regulations while employed?

Yes

No

Was your job designated as a safety-sensitive function in a DOT regulated mode subjected to the drug and alcohol testing requirements of 49 CFR Part 40?

Yes

No

Type of vehicle driven

Approximate mileage driven

Class A Driver and Mechanic Applicants Only:

Headquarters: Home and Away Ministries 5833 Pecan St. North Branch MN 55056 | Company Warehouse Locations: 39404 North Branch, MN 55056 717 10th St Waupaca, WI 54981

Name(Required)

First Middle Last

Phone(Required)

Date Of Birth(Required)

Hire Date:

(Leave blank)

*The Federal Motor Carrier Safety Regulations (49 CFR 391.21(b)(2) requires that driver applicants provide their date of birth and social security number. If you are considered for hire, we will call you for your Social Security Number.

Current Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

PAST 3 YEARS OF RESIDENCY

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Physical History – Health Card

The Federal Motor Carrier Safety Regulations (49 CFR 391 Subpart E) require that all driver applicants pass certain medical examinations before they are hired to drive a motor vehicle.

Date of last Department of Transportation medication examination:(Required)

Can you provide a copy of this?(Required)

Yes

No

Have you ever been granted a waiver under section 391.49 of the Federal Motor Carrier Safety Regulations pertaining to the loss of a limb (i.e. foot, leg, hand, arm)?(Required)

Alcohol and Controlled Substance Statement

The Federal Motor Carrier Safety Regulations (49 CFR 40.25) requires that all persons applying for a driving position requiring a commercial driver’s license to answer the following questions:

Within the past (2) years, have you ever tested positive or refused to test, on any pre-employment drug or alcohol test administered by the employer to which you applied for, but did not obtain, safety-sensitive transportation work?(Required)

Yes

No

Within the past (2) years, have you ever tested positive, or refused to test, on any type of drug or alcohol test administered by an employer for which you performed safety-sensitive transportation work?(Required)

Yes

No

APPLICANT’S STATEMENT:

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

Signature(Required)

Date(Required)

Printed Name(Required)

First Middle Last

Class A Truck Driver — Ruby's Pantry

Apply Now

We drug test for pre-employment, suspicion, post-accident and random monthly.

EDUCATION

EMPLOYMENT

#1 Employer

#2 Employer

#3 Employer

#4 Employer

#5 Employer

Class A Driver and Mechanic Applicants Only:

*The Federal Motor Carrier Safety Regulations (49 CFR 391.21(b)(2) requires that driver applicants provide their date of birth and social security number. If you are considered for hire, we will call you for your Social Security Number.

PAST 3 YEARS OF RESIDENCY

Driving Experience

List all accidents (from the most recent)

List all violations

Physical History – Health Card

Alcohol and Controlled Substance Statement

APPLICANT’S STATEMENT:

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Our Family of Ministries

DESIGNATION

DESIGNATION

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