EMPLOYMENT APPLICATION FORM

First Name *

Middle Name *

Last Name *

E-Mail Address *

Phone *

Mobile # *

Street Address *

City

State

Zipcode

I prefer a position that is: Please SelectDriverOperationsClericalAdministrativeConstructionManual / PhysicalManagementOther

Position I am interested in: Please SelectTruckload DriverForklift DriverTruck RepairWarehouse WorkerFreight or Material HandlingExpedited or Rail ServicesTrailer & Equipment RentalProperty RentalIndustrial/Commercial RecyclingOther / Not Listed

Are You Eligible to Work in the U.S? Please SelectYes - US CitizenYes - Non-citizen w/ Work AuthorizationNo

Most Recent Employer *

Start Date *

End Date *

Your Position *

Direct Supervisor’s Name *

Employer Phone # *

Second Most Recent Employer *

Start Date *

End Date *

Your Position *

Direct Supervisor’s Name *

Employer Phone # *

Name of Reference #1 *

Relationship to Reference

Phone # *

Name of Reference #2 *

Relationship to Reference

Phone # *

Why Do You Want to Work for Clark Logic?

List Any Certifications: (e.g. CDL)

Other Details We Should Know About You:

By Checking this Box I certify that the above information is true and correct, and I give permission to Clark Logic to contact the employers and references who are listed. *

3 + 1 = ? Please prove that you are human by solving the equation *