Position applying for:  Specific Job # VIEW AVAILABLE JOBS

Which area would you like to work?

Have you ever applied to CCI before? 

If you were referred to CCI by an existing driver, who referred you?

PERSONAL INFORMATION

Name
Street Address Apt #
City/State

   ZIP

Home Phone Cell Phone
Pager or FAX E-mail
Date of Birth

EDUCATION

Highest Level  of Education Completed
Last year attended school
Other Education or Certifications:


DRIVING HISTORY

What type of Drivers License do you currently have? Issued in what state?

 

How many accidents have you been involved within the previous 5 years?

How many claims have you presented to YOUR insurance company in the last 5 years?

EMPLOYMENT HISTORY

Are you currently employed?   

How much notice do you need to give?

List jobs starting with most recent.

Job #

Employed

 Company Name City/State Phone Brief Description of Duties
From: To:
1
2
3

Are you bondable?  

Have you ever filed for bankruptcy?  

Have you ever been convicted of a felony?  

Are you willing to submit to a drug screen?  

INDEPENDENT CONTRACTOR POSITIONS

If you are applying for any independent contractor (TYPE = "IND") positions, please complete the following section.

Have you ever worked as an independent contractor in the past?

Vehicle Year Vehicle Make Vehicle Model

Our insurance carrier requires that all independent contractors working for CCI carry a minimum of $300,000 per occurrence in Liability Insurance.  

What levels of insurance do you currently have?

If you do not currently carry the required amount, are you willing to update your policy to the required levels?

Please review your information before submitting for accuracy.  Because this form is being submitted via a server that is not secure, your Social Security Number and Driver License Number are not being requested.  If contacted for an interview based on the information provided via this form, you will be asked to complete a standard CCI application.

By clicking on the Send button below you are electronically signing this form and stating that you understand:

1.    any misrepresentation or omission of facts requested in this form is cause for dismissal, if hired, and

2.    if hired, employment is for no definite period and regardless of the date of payment of wages and salary, you may be terminated at any time without prior notice.

Please submit this form only once.  

SUBMIT RESUME

Last updated Friday, May 02, 2008 14:37 EST