On-Line Application


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Welcome On-Line Applicants

Thank you for your interest in E.L. Hollingsworth and Company. If you have started or filled out an application with us before within the past year click here to see if we still have it on file.

 

ELECTRONIC AGREEMENT

E.L. Hollingsworth & Co. does not, nor will not sell your information to a third party. We keep your information on hand only for our internal use after you submit an electronic application. Be aware that we keep all of our information protected, and under stringent security measures. All information that you are submitting to E.L. Hollingsworth & Company is submitted using encryption. This encryption will make sure that your information, i.e. - Social Security Number does not fall to an unintended person. You agree that if you submit an application to E.L. Hollingsworth & Company that you give us the permission to run a background check, or reference check. Your application will stay on file for one year from submittal.

Personal Info

* Required Information

Addresses

Required: Please enter your current address, along with any address(es) prior in the last 3 years.

Address City State Zip
CURRENT ADDRESS
PAST ADDRESSES
Emergency Contact

* Required Information

Is your emergency contact's address different than above?

General Education

College / Technical Education

* Required Information

Pre-Employment Questions

General Information

Driver Notification and Release

In connection with my application for employment (including contract services) with E.L. Hollingsworth & Co., I understand that an investigative consumer report is being requested from DAC Services, Tulsa, Oklahoma. This will include information as to my character, work habits, performance and experience, along with reasons for terminations of past employment from previous employers. Further, I understand that the company will be requesting information concerning my driving record and/or information from various federal, state and other agencies which maintain records concerning traffic offenses, accidents, etc. As well as information from DAC concerning (1) previous driving record request made by others such as state agencies; (2) state provided driving records; (3) claims involving me in the files of insurance companies.

I AUTHORIZE, WITHOUT RESERVATION; ANY PARTY OR AGENCY CONTACTED BY DAC TO FURNISH THE ABOVE-MENTIONED INFORMATION.

I have a right to make a written request within reasonable period of time to receive additional detailed information about the nature and scope of this investigation. I hereby consent to E.L. Hollingsworth & Co. obtaining the above information from DAC, and agree that such information which DAC has or obtains, and my employment history with you if I am hired, will be supplied by DAC to other companies, which subscribe to DAC's services.

If hired, I agree I will serve at the will of the Company, and I agree that I shall be bound by the rules, policies, regulations and terms and conditions of employment of the Company as they are from time to time changed with or without notice to me. I AGREE THAT EITHER PARTY MAY TERMINATE THE EMPLOYMENT RELATIONSHIP, WITH OR WITHOUT CAUSE, AT ANY TIME. I agree that these arrangements may only be altered in writing directed to me personally by the President of the Company. I further agree that my employment is conditional upon satisfactory completion of documentation as required by the Immigration Reform and Control Act of 1986 and the results of my pre-employment physical and pre-employment drug screen as stated in the FMCSR (Federal Motor Carrier Safety Regulations) section 40.382.1 are known.

FMCSA Pre-Employment Screening Release

1. In connection with your application for employment with E.L. Hollingsworth & Co. ("Prospective Employer"), it may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA).

When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report.

When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA: that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving you request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act.

The Prospective Employer cannot obtain background reports from FMCSA unless you consent in writing.

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:

2. I authorize ELHC ("Prospective Employer") to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am consenting to the release of safety performance information including crash data from the previous five (5) years and inspection history form the previous three (3) years. I understand and acknowledge that this release for information may assist the Prospective Employer to make a determination regarding my suitability as an employee.

3. I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I am challenging crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication.

4. Please note: Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.

Previous Employee

Have you ever worked for E.L. Hollingsworth & Co., Chieftain Contract Services, or H.E.L.P.
( Hollingsworth Expedited Lane Partners) Before?

   

Employment History

** ALL DRIVER APPLICANTS: TO DRIVE IN INTERSTATE COMMERCE, YOU MUST PROVIDE THE FOLLOWING INFORMATION ON ALL EMPLOYERS DURING THE PRECEDING TEN (10) YEARS. PLEASE LIST COMPLETE MAILING ADDRESS, STREET NUMBER, ZIP CODE. APPLICANTS DRIVING A COMMERCIAL MOTOR VEHICLE (INTRASTATE OR INTERSTATE COMMERCE) MUST ALSO PROVIDE AN ADDITIONAL 7 YEARS INFORMATION ON THOSE EMPLOYERS. FOR WHOM THE APPLICANT OPERATED SUCH A VEHICLE.

You must enter at least the past 10 years of your employement history.

Past Employer 1

Past Employer 2

Past Employer 3

Past Employer 4

Past Employer 5

Past Employer 6

Past Employer 7

Past Employer 8

Past Employer 9

Past Employer 10

Past Employer 11

Past Employer 12

Past Employer 13

   

Driving Information

Accidents

Have you had any accidents in the past 5 years?

List all accidents that have happened in the past 5 years, starting with the most recent.

Date MM/YYYY Nature of Accident # Injured # Fatalities
Driving Record

Have you had any traffic violations in the past 5 years?

List all traffic violations you have had in the past 5 years, starting with the most recent one.

Date (MM/YYYY) Location Type of Violation Penalty Points
Driver's License(s)

Please list current license held first, along with any other drivers license's held within the past 10 years.

State License Number Type Expiration Date
Driving Experience

List experience on class of equipment

Class of Equipment Type of Equipment Dates (MM/YYYY) Approx. Total Miles
to
to
to
to
General Questions

Please answer as many questions as you can below