Employment | Burkhart Enterprises

Your Personal Information

Your Name*

First Last

Your Email Address*

Enter Email Confirm Email

Your Phone*

Best Time To Call You*

When is the best time for us to reach you via telephone?

Date of Birth*

Can you provide proof of age?*

Yes
No

(Required for Truck Drivers)

Current Address*

Street Address Unit / Suite Number City State Zip Code

Have you lived at the above address for three years or more?*

Yes
No

Previous Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Position You're Applying For

Position You're Applying For:*

Are you eligible to work in the United States?*

Yes
No

Are you a Veteran?*

Yes
No

Which Branch?*

Have you ever worked for Burkhart Enterprises before?*

Yes
No

From:*

To:*

Are you currently employed?*

Yes
No

How long has it been since you were last employed?*

Referred by:

Expected Rate of Pay:*

Is there any reason why you may not be able to perform the function of the job for which you are applying? Explain.

Previous Employment

All driver applicants must provide the following information on all employers during the preceding 3 years. This includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicles used to transport hazardous materials in a quantity requiring placarding.

Applicants to drive a commercial motor vehicle in intrastate or interstate commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such a vehicle.

Your Previous Employers*

Please list your previous employers, the dates you worked and the position you held

Employer	Supervisor	Dates	Position	Salary	Reason for Leaving	Phone

Accident Record For Past Three Years*

Date	Nature of Accident	Fatalities	Injuries

Traffic Convictions For Past Three Years (Other than parking violations.)*

Location	Date	Charge	Penalty

Education, Experience, and Qualifications

Highest Education Completed*

Last School Attended*

Driving Experience*

State	License No.	Type	Expiration Date

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

Yes
No

Has any license, permit, or privilege ever been suspended or revoked?*

Yes
No

Please Explain Why:*

Driving Experience*

Class	Type	From (Date)	To (Date)	Approx. Number Miles

List states you've operated in for the past five years:*

What special courses or training have you completed that will help you as a driver?*

Which safe driving awards do you hold and from whom?*

What trucking, transportation, or other experience do you have that may help in your work for this company?*

List courses and training other than what you’ve already listed:*

List special equipment or technical materials you can work with:*

Upload Your Resume

Accepted file types: pdf, doc, docx, Max. file size: 100 MB.

upload your resume in .pdf, .doc or .docx format

I hereby authorize you to release the following information to BURKHART ENTERPRISES, INC. for purposes of investigation as required by Section 391.23 of the Federal Motor Carrier Safety Regulations. You are released from any and all liability, which may result from furnishing such information.*

I agree

Disclosure and Authorization Regarding Background Investigation for Employment Purposes

Burkhart Enterprises, Inc. may request from a consumer reporting agency and for employment-related purposes, a “consumer report(s)” (commonly known as “background reports”) containing background information about you in connection with your employment, or application for employment, or engagement for services (including independent contractor or volunteer assignments, as applicable).

The background report(s) may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing. The types of background information that may be obtained include, but are not limited to: criminal history; litigation history; motor vehicle record and accident history; social security number verification; address and alias history; credit history; verification of your education, employment and earnings history; professional licensing, credential and certification checks; drug/alcohol testing results and history; military service; and other information.

By agreeing to the above you hereby authorize Burkhart Enterprises, Inc. to obtain the consumer reports described above about you.*

I agree

Important Disclosure Regarding Background Reports from the PSP Online Service

In connection with your application for employment with Burkhart Enterprises, Inc. (“Prospective Employer”), Prospective Employer, its employees, agents or contractors 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 your 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.

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. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication.

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 Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.

The Prospective Employer cannot obtain background reports from FMCSA without your authorization.

AUTHORIZATION

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

I authorize Burkhart Enterprises, Inc. (“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 authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.

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 challenge 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.

I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report.

I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above

NOTICE: This form is made available to monthly account holders by NIC on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant’s written or electronic consent prior to accessing the Applicant’s PSP report. Further, account holders are required by FMCSA to use the language contained in this Disclosure and Authorization form to obtain an Applicant’s consent. The language must be used in whole, exactly as provided. Further, the language on this form must exist as one stand-alone document. The language may NOT be included with other consent forms or any other language.

NOTICE: The prospective employment concept referenced in this form contemplates the definition of “employee” contained at 49 C.F.R. 383.5.

By agreeing to the above, you acknowledge that you have read the Disclosure Regarding Background Reports provided to you by Prospective Employer and you understand that if you sign this Disclosure and Authorization, Prospective Employer may obtain a report of your crash and inspection history. You hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.*

I agree

Terms and Conditions

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment financial, or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with this application. In the event of my employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

By agreeing to the above, you acknowledge that you have read the terms and conditions.*

I agree.

Name

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