MAC CDL Training & Recruiting

MAC CDL Training & Recruiting Inc.

dba MAC Truck Training &

MAC Street Rider Motorcycle Safety Program

2221 Niagara Falls Blvd. Suite 3 Niagara Falls, NY 14304

Office (716) 216-4460 Fax (716) 216-4461
Email: mac326@aol.com

General Info

License Info

Safety Info

General Information

First Name:
Middle Initial:
Last Name:
Address:
City:
State:
Zip:
How did you hear about Central?:
Assignment Desired:
SSN/FED ID:
Date of Birth
Gender
Spouse's Name:
Phone:
Email:
Are you working with a recruiter?

License Information

License Number:		Months Experience:
License State:		Equipment:
License Date:		Engine Size:
License Expiration:		Licenses held in the last 3 years:
Haz-Mat Endorsement?:	Yes No

Safety Information

Number of tickets in the last 3 years: Explanation:		Number of accidents in the last 3 years: Explanation:

Have you EVER been convicted or arrested for a felony? Yes No Explanation:		Has your license EVER been revoked? Yes No Explanation:

Driving School

Experienced drivers do not need to enter driving school information

Graduate Student I am an Experienced Driver

Driving School Name:
School Phone:
Graduation Date:
City:
State:

References

Reference 1

Reference 2

Reference 3

Name:
Title:
Phone:
Email:

Name:
Title:
Phone:
Email:

Name:
Title:
Phone:
Email:

Work History

Current or last employer 1:
From Date:
To Date:
Phone:
Job Title:
Address:
City:
State:
Reason for leaving?:
Number of states operated in:
Eligible for rehire?	Yes No

Current or last employer 2:
From Date:
To Date:
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Job Title:
Address:
City:
State:
Reason for leaving?:
Number of states operated in:
Eligible for rehire?	Yes No

Current or last employer 3:
From Date:
To Date:
Phone:
Job Title:
Address:
City:
State:
Reason for leaving?:
Number of states operated in:
Eligible for rehire?	Yes No

Current or last employer 4:
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Reason for leaving?:
Number of states operated in:
Eligible for rehire?	Yes No

Current or last employer 5:
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Phone:
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Address:
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Reason for leaving?:
Number of states operated in:
Eligible for rehire?	Yes No

Current or last employer 6:
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To Date:
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Address:
City:
State:
Reason for leaving?:
Number of states operated in:
Eligible for rehire?	Yes No

Current or last employer 7:
From Date:
To Date:
Phone:
Job Title:
Address:
City:
State:
Reason for leaving?:
Number of states operated in:
Eligible for rehire?	Yes No

Current or last employer 8:
From Date:
To Date:
Phone:
Job Title:
Address:
City:
State:
Reason for leaving?:
Number of states operated in:
Eligible for rehire?	Yes No

Current or last employer 9:
From Date:
To Date:
Phone:
Job Title:
Address:
City:
State:
Reason for leaving?:
Number of states operated in:
Eligible for rehire?	Yes No

Comments:

I authorize Central Refrigerated Service, Inc. and/or its agents, including consumer reporting bureaus, to verify any of the information I have provided, included but not limited to criminal history and motor vehicle driving records: Yes No