Application For Employment

Thank you for your interest in potential employment with Village Shed Store, and for visiting our Employee Application.

We encourage you to submit your Online Application by using the form below.

Or submit your resume and job application (Download Application here) to villageshedstore@gmail.com.

*Please be advised to Complete form in full or it will not be considered.

 

 

    APPLICANT INFORMATION

    Do you have legal right to work in the United States?:

    PREVIOUS THREE YEARS RESIDENCY

    Click "+" icon below for additional row if needed.

    STREET
    CITY
    STATE
    ZIP CODE
    # OF YEARS AT ADDRESS
    CURRENT
    MAILING
    PREVIOUS

    LICENSE INFORMATION

    No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past 3 years; click "+" icon below for additional row if needed.

    STATE
    LICENSE #
    TYPE/CLASS
    ENDORSEMENTS
    EXPIRATION DATE
    PREVOIUSLY HELD LICENSES

    DRIVING EXPERIENCE

    CLASS OF EQUIPMENT
    TYPE OF EQUIPMENT (VAN, TANK, FLAT, ETC.)
    DATE FROM
    DATE TO
    APPROX # OF MILES (TOTAL)
    STRAIGHT TRUCK
    TRACTOR & SEMI-TRAILER
    TRACTOR & 2 TRAILERS
    TRACTOR & TANKER
    OTHER

    ACCIDENT RECORD FOR THE PAST 3 YEARS

    Skip if none. Click "+" icon below for additional row if needed.

    DATES (List most recent first)
    NATURE OF ACCIDENT (Head-on, rear-end, upset, etc.)
    # FATALITIES
    # INJURIES
    CHEMICAL SPILLS (Y/N)

    TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)

    Skip if none. Click "+" icon below for additional row if needed.

    DATE CONVICTED (Month/Year)
    VIOLATION
    STATE OF VIOLATION
    PENALTY (Forfeited bond, collateral and/or points)

    Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
    If yes, explain

    Has any license, permit, or privilege ever been suspended or revoked?
    If yes, explain

    EMPLOYMENT HISTORY

    The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additionalseven (7) years (for a total of ten (10) years). Any gaps in employment in excess of one (1) month must be explained.

    Start with the last or current position, including any military experience, and work backwards(attach separate sheets if necessary). You are required to list the complete mailing address, including street number, city, state,zip; and complete all other information.

    CURRENT (MOST RECENT) EMPLOYER

    While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

    Wasthe job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substancestesting asrequired by 49 CFR, part 40?

    SECOND (MOST RECENT) EMPLOYER

    While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

    Wasthe job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substancestesting asrequired by 49 CFR, part 40?

    THIRD (MOST RECENT) EMPLOYER

    While employed here, were you subject to the Federal Motor Carrier Safety Regulations?

    Wasthe job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substancestesting asrequired by 49 CFR, part 40?

    EDUCATION

    SCHOOL
    NAME & LOCATION
    COURSE OF STUDY
    YEARS COMPLETED
    GRADUATE (Y/N)
    DETAILS
    High School
    College
    Other School

    OTHER QUALIFICATIONS

    TO BE READ AND SIGNED BY APPLICANT

    I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. 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 also understand that I am required to abide by all rules and regulations of the Company.

    I understand that the information I provide regarding my current and/or prior employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23. I understand that I have the right to:

    • Review information provided by current/previous employers;
    • Have errors in the information corrected by previous employers, and for those previous employers to resend the corrected information to the prospective employer; and
    • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

    This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.

    After completion, please return this form to Village Shed Store, 5908 Boydton Plank Rd, N. Dinwiddie, Virginia, 23803, or fax to: 804-894-8097, or email to: Villageshedstore@gmail.com