Job Application Form Step 1 of 4 25% Applicant Contact InformationYour Name(Required) First Middle Last Your Email Address(Required) Enter Email Confirm Email Main Phone(Required)Secondary PhoneAddress(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Have you lived at any other address(es) in the past 3 years?(Required) Yes No Please list previous three years of residency (CDL-A APPLICANTS ONLY)StreetCityStateZipNumber of years at address Add RemoveDate Available for Work(Required) MM slash DD slash YYYY This field is hidden when viewing the formDate MM slash DD slash YYYY Work RequirementsAre you legally authorized to work in the United States?(Required) Yes No Are you at least 18 years of age?(Required) Yes No Is an accommodation necessary to perform the essential duties of the position?(Required) Yes No Have you ever been convicted of a crime?(Required) Yes No Please explain(Required)If you've ever been convicted of a crimeEducation & MilitaryEducation History(Required)Indicate the type of school (High School, Trade School, College, Other)School LevelName of SchoolCourse of StudyYears CompletedGraduated? Add RemoveDid you serve in the US Military?(Required) Yes No Relevant education, training, or work experience while in the military(Required)Brink Family of Companies Location and Job InformationWhich Brink Family of Companies business or location are you interested in?(Required)Please specify below (check all that apply) or choose "Select All" if you're willing to work at any of the locations. Brink Farms (Hamilton, MI) Brink Transfer Services (Hamilton & New Buffalo, MI) Mark Harwell Trucking (Quincy, MI) Brink Railroad-Transload (Bay City, Bridgman, Grand Rapids, Muskegon, MI) Brink Terminal Services (Bay City & Muskegon, MI) Bridgman Terminal (Bridgman, MI) Ottawa Lake Terminal (Ottawa Lake, MI) Select AllWhich job(s) are you applying for?(Required)Don't worry about specific job location yet; just choose between CDL-A DriverDiesel MechanicGeneral Job HistoryPlease list current (or most recent employer) as well as any additional employers over the last 3 years.Current Employer Name(Required)Current Position(Required)Current Employer's Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Current Employer's Phone(Required)Start Date(Required) MM slash DD slash YYYY Reason for leaving(Required)Do you need to add an additional previous employment? Yes No Past Employer Name(Required)Position(Required)Employer's Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Employer's Phone(Required)Start Date(Required) MM slash DD slash YYYY End Date(Required) MM slash DD slash YYYY Reason for leaving(Required)Do you need to add an additional previous employment? Yes No Past Employer Name(Required)Position(Required)Employer's Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Employer's Phone(Required)Start Date(Required) MM slash DD slash YYYY End Date(Required) MM slash DD slash YYYY Reason for leaving(Required)Diesel Mechanic ApplicationPlease list any ASE or State of Michigan certifications.Add as many lines as needed. Add RemoveHow many years of heavy duty truck experience do you have? Describe.Add as many lines as needed. Add RemoveList and describe your engine experience.Add as many lines as needed. Add RemoveList and describe your drive train experience.Add as many lines as needed. Add RemoveList and describe your welding experience.Add as many lines as needed. Add RemoveList and describe your air conditioning experience.Add as many lines as needed. Add RemoveList and describe your tire experience.Add as many lines as needed. Add RemoveCDL-A Driver ApplicationPlease note, you will be required to pass a DOT Drug test with Hair Follicle, and your driving record will be checked.License InformationLicenses & Endorsements(Required)List any license information here.StateType/ClassEndorsementsExpiration Add RemoveHas your license ever been suspended or revoked?(Required) Yes No Have you ever been denied a license, permit, or privilege to operate a motor vehicle?(Required) Yes No Please specify the dates and reasons for your license being suspended or revoked.(Required)Please explain why you were denied a license, permit, or privilege to operate a motor vehicle.(Required)Have you been involved in any accidents in the past 3 years?(Required) Yes No Have you had any moving violations in the past 3 years?(Required) Yes No Please list accidents below.(Required)Please list the nature of the accident (head-on, rear-end, upset, etc.), if there were injuries or fatalities and how many, or a chemical spill.DateWhat happened?Who was at fault? Add RemovePlease list moving violations below.(Required)DateType of violation Add RemoveHave you had any traffic convictions or forfeitures in the past 3 years (excluding parking violations)? Yes No List any traffic convictions or forfeitures(Required)DateViolationStatePenalty (forfeited bond, collateral, and/or points) Add RemoveDriving ExperienceEquipment Class Type(Required)Straight TruckTractor and Semi TrailerDoublesHopperPneumaticTankerOtherYears of Experience(Required)Add More?(Required) Yes No Equipment Class Type(Required)Straight TruckTractor and Semi TrailerDoublesHopperPneumaticTankerOtherYears of Experience(Required)Add More?(Required) Yes No Equipment Class Type(Required)Straight TruckTractor and Semi TrailerDoublesHopperPneumaticTankerOtherYears of Experience(Required)Add More?(Required) Yes No Equipment Class Type(Required)Straight TruckTractor and Semi TrailerDoublesHopperPneumaticTankerOtherYears of Experience(Required)Add More?(Required) Yes No Equipment Class Type(Required)Straight TruckTractor and Semi TrailerDoublesHopperPneumaticTankerOtherYears of Experience(Required)Employment HistoryThe Federal Motor Carrier Safety Regulations (49 CFR 391.21) requires previous employment history, including military experience and including explanations of gaps in employment history of greater than 1 month.Choose one:(Required)If you have recently obtained or don't have a current CDL, we will need at least 3 years of past work experience. If you have your CDL already and have driven a commercial vehicle previously, we will need at least 10 years of past work experience filled out. I have recently obtained my CDL or I do not currently have a CDL (we will need at least 3 years of past work experience). I have my CDL and have driven a commercial vehicle previously (we will need at least 10 years of past work experience). Current (or most recent) Employer Name(Required)Employer Phone(Required)Current (or most recent employer) Address(Required) Street Address Address Line 2 City State State / ProvinceAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Position Held(Required)Start Date(Required) MM slash DD slash YYYY End Date(Required)If you are still employed here, just enter today's date. MM slash DD slash YYYY Reason for leaving(Required)While employed here, were you subject to the Federal Motor Carrier Safety Regulations?(Required) Yes No Was the job designated as a safety-sensitve function in any Department of Transportation regulated mode subject to alcohol and controlled substance testing as required by 49 CFR, part 40?(Required) Yes No Do you need to add an additional previous employment?(Required) Yes No Previous Employer Name(Required)Previous Employer Phone(Required)Previous Employer's Address(Required) Street Address Address Line 2 City State / ProvinceAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position Held(Required)Start Date(Required) MM slash DD slash YYYY End Date(Required)If you are still employed here, just enter today's date. MM slash DD slash YYYY Reason for leaving(Required)While employed here, were you subject to the Federal Motor Carrier Safety Regulations?(Required) Yes No Was the job designated as a safety-sensitve function in any Department of Transportation regulated mode subject to alcohol and controlled substance testing as required by 49 CFR, part 40?(Required) Yes No Do you need to add an additional previous employment?(Required) Yes No Previous Employer Name(Required)Previous Employer Phone(Required)Previous Employer's Address(Required) Street Address Address Line 2 City State / ProvinceAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position Held(Required)Start Date(Required) MM slash DD slash YYYY End Date(Required)If you are still employed here, just enter today's date. MM slash DD slash YYYY Reason for leaving(Required)While employed here, were you subject to the Federal Motor Carrier Safety Regulations?(Required) Yes No Was the job designated as a safety-sensitve function in any Department of Transportation regulated mode subject to alcohol and controlled substance testing as required by 49 CFR, part 40?(Required) Yes No Do you need to add an additional previous employment?(Required) Yes No Previous Employer Name(Required)Previous Employer Phone(Required)Previous Employer's Address(Required) Street Address Address Line 2 City State / ProvinceAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position Held(Required)Start Date(Required) MM slash DD slash YYYY End Date(Required)If you are still employed here, just enter today's date. MM slash DD slash YYYY Reason for leaving(Required)While employed here, were you subject to the Federal Motor Carrier Safety Regulations?(Required) Yes No Was the job designated as a safety-sensitve function in any Department of Transportation regulated mode subject to alcohol and controlled substance testing as required by 49 CFR, part 40?(Required) Yes No Do you need to add an additional previous employment?(Required) Yes No Previous Employer Name(Required)Previous Employer Phone(Required)Previous Employer's Address(Required) Street Address Address Line 2 City State State / ProvinceAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Position Held(Required)Start Date(Required) MM slash DD slash YYYY End Date(Required)If you are still employed here, just enter today's date. MM slash DD slash YYYY Reason for leaving(Required)While employed here, were you subject to the Federal Motor Carrier Safety Regulations?(Required) Yes No Was the job designated as a safety-sensitve function in any Department of Transportation regulated mode subject to alcohol and controlled substance testing as required by 49 CFR, part 40?(Required) Yes No If you have commercial driving experience, have you listed the required past 10 years of employment above?(Required) Yes No Do you have any employment gaps of greater than 1 month?(Required)The Federal Motor Carrier Safety Regulations (49 CFR 391.21) requires previous employment history, including military experience and including explanations of gaps in employment history of greater than 1 month. Yes No Please explain any gaps in employment greater than 1 month.(Required)Add more lines as needed.Length of timeExplanation Add RemoveDrivers License Number(Required)Drivers License Copy(Required)Please attach a photo copy of your drivers license here Drop files here or Select files Max. file size: 100 MB, Max. files: 2. Final AuthorizationDo you have any other comments you would like to share about your application?If so, please share below.Final Certification(Required)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. Brink Farms, Inc., Brink Transfer Services, Inc., Mark Harwell Trucking, Inc., Brink Terminal Services, Inc., Bridgman Terminal Services, LLC and Ottawa Lake Terminals, LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Brink Farms, Inc. Brink Transfer Services, Inc., Mark Harwell Trucking, Inc., Brink Terminal Services, Inc., Bridgman Terminal Services, LLC and Ottawa Lake Terminals, LLC complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the respective company. 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. Check this box as a digital signature.NameThis field is for validation purposes and should be left unchanged. Δ
