First Name*
Last Name*
Email Address*
Phone*
Do you have a valid driver's license?
No answer Yes No
What's your citizenship / employment eligibility?
No answer I am a U.S. Citizen/Permanent Resident Non-citizen allowed to work for any employer Non-citizen allowed to work for current employer Non-citizen seeking work authorization I am a Canadian Citizen/Permanent Resident Other
Are you 18 years of age or older?
No answer Yes No
Earliest start date?
Can you work weekends?
No answer Yes No
Can you work evenings?
No answer Yes No
Can you work overtime?
No answer Yes No
Have you ever been convicted of a felony?
No answer No Yes
If “Yes”, you have been convicted of a felony, please explain the circumstances around the conviction:
References: Please enter names and contact information:
Have you ever filed an application with us before or been employed with us previously?*
-- No answer -- Yes No
If you are currently employed, may we contact your present employer?
-- No answer -- Yes No
Do you hold a valid and current TWIC?*
-- No answer -- Yes No
TWIC Expiration Date (YYYY-MM-DD)?
Do you hold a valid and current U.S. Coast Guard Merchant Mariner's Document (MMD)?*
-- No answer -- Yes No
If yes, what is your reference number?
MMD First/Original Issue Date (YYYY-MM-DD) format:
MMD Current Expiration Date (YYYY-MM-DD):
MMD Current Issue Date (YYYY-MM-DD):
Trainees and Tankermen are required to have a valid driver license and auto insurance. Do you have a valid driver license and auto insurance?*
-- No answer -- Yes No Not currently, but I will obtain this and provide proof before hire.
Employment History: Please list your most recent or current employer:*
Employment History: What were your dates of employment there?*
Employment History: What was your most recent job title/position held and brief description of duties:*
Employment History: What was/is your reason for leaving your last employer? If you are still employed, why are you considering leaving?*
Employment History: Please list your past supervisor name and phone.*
Previous Employment History Continued: Please list your previous employer and dates of employment there:
Previous Employment History: What were your dates of employment there?
Previous Employment History Continued: What was your job title/position held and brief description of duties:
Previous Employment History Continued: What was/is your reason for leaving this employer?
Previous Employment History Continued: Please list your past supervisor name and phone.
Previous Employment History: If there are any other prior employers in the past 5 years, please list them here:
Do you have any military service? If so, what branch and any special training received?
Do you have any vocational training? Check all that apply.
For any of the above training you may have identified, please describe the school where training was received, dates of training, and if a certificate was awarded?
Do you have experience in the following types of cargo transfer operations?
Have you had a DWI in the last 3 years or more than 2 moving violations in the past 3 years? (Answering yes does NOT automatically disqualify you from employment.)*
-- No answer -- Yes No
Are you currently on probation or have any charges pending?*
-- No answer -- Yes No
In accordance with 49 CFR Part 40 Section 40.25 (j), AccuTRANS is required to ask Tankerman applicants the following questions. In the past 2 years, have you tested positive on a DOT pre-employment drug OR alcohol test administered by a potential DOT agency/employer?*
In the past 2 years, have you REFUSED to submit to a DOT pre-employment drug and alcohol test administered by a potential DOT agency/employer?*
If you answered yes to any of the above, have you undergone a return-to duty process, and can you provide documentation of successfully completing the return to duty process?
-- No answer -- Yes No
I certify that all the information on this application is accurate, true, and complete to the best of my knowledge. I understand that the omission and/or misrepresentation of any fact or misleading/false statements will constitute sufficient cause for refusal to hire or termination of my employment.*
