Online Application:

Please take a few minute to carefully fill out the online application. After you have entered ALL your information, click Submit My Application and your information will be sent to Cooper Trucks. Someone will contact you shortly -- thank you for your interest in working with us!

Personal Information

First Name

Last Name

nnn-nn-nnnn

Social Security Number

Phone

Position Desired

Available Start Date

Address

Street Address

City

State

Zip

How long have you lived at the above address?

If less than three years, list previous addresses:

Street Address

City

State

Zip

How long?

Street Address

City

State

Zip

How long?

Street Address

City

State

Zip

How long?

In case of emergency, contact:

Name

Phone

Have you ever been employed with Cooper/Kenworth Leasing, Inc. before? Yes No

If yes, list dates of employment:

Will you accept: Full Time Part-time

What is your preferred shift? First Second

Will you work overtime, if asked? Yes No

Do you have the legal right to reside in this country? Yes No

If hired, can you provide documentation as proof? Yes No

Have you ever been convicted of any crime other than a minor traffic violation? Yes No

If yes, please state the crime and the results of the court case:

Education

College

School Name & Address

Course of Study

Yes No

Did you graduate?

Degree or diploma

Trade/Business School

School Name & Address

Course of Study

Yes No

Did you graduate?

Degree or diploma

High School

School Name & Address

Course of Study

Yes No

Did you graduate?

Degree or diploma

Employment History

Company Name

Company AddressAddress

Telephone

Position Held

Salary

Reason for leaving

Employment Dates: From to

Responsibilities

Name of Supervisor

Company Name

Company AddressAddress

Telephone

Position Held

Salary

Reason for leaving

Employment Dates: From to

Responsibilities

Name of Supervisor

Company Name

Company AddressAddress

Telephone

Position Held

Salary

Reason for leaving

Employment Dates: From to

Responsibilities

Name of Supervisor

Company Name

Company AddressAddress

Telephone

Position Held

Salary

Reason for leaving

Employment Dates: From to

Responsibilities

Name of Supervisor

Membership in Professional or Civic Organizations

(Exclude those which may disclose your race, religion, or national origin)

Military

Did you serve in the armed forces? Yes No If so, what branch?

Describe any training received relevant to the position for which you are appying:

ALL APPLICANTS MUST COMPLETE THE FOLLOWING SECTION:

Drivers License State

Drivers License Number

Type/Class

Expiration Date

A. Have you ever been denied a license, permit, or privilege to operate a motor
vehicle? Yes No

B. Has any license, permit, or privilege been revoked? Yes No

C. Have you ever been disqualifed subject to section 391 or the Federal Motor Carrier Safety Regulations? Yes No

**IF YOU ANSWERED YES TO EITHER A, B, OR C, PLEASE WRITE A DESCRIPTION BELOW:

Mechanics and Drivers only - complete this section

I'm not appying for a mechanic or driver position -- let's skip this part.

Maintenance Experience and Qualifications - List experience and training in maintenance work

Indicate training and experience in the following:

Training	Years Exp.	Area	Years Exp
Drive Line Components	years	Body Work	years
Diesel Engine Tune-up & Rebuild	years	Electrical Repair	years
Gas Engine Tune-up & Rebuild	years	Frame & Wheel Alignment	years
Tire Service	years	Brakes	years
Trailer Repair	years	Cooling Systems	years
Preventative Maintenance	years	Safety Line Checking	years

Indicate equipment you can operate

Equipment	Years Exp.	Equipment	Years Exp
Woodworking Equipment	years	Wheel & Tire Balancing Mechanic	years
Sheet Metal Equipment	years	Tire Recapping Mold	years
Frame & Axle Straightening Equipment	years	Engine Dynamometer	years
Engine Rebuilding Equipment	years	Chassis Dynamometer	years
Diesel Injection Equipment	years	Magnetic Crack Detector	years
Electric Welder	years	Engine Analyzer	years
Oxyacetylene Welder	years	Noise Measuring Equipment	years

References

Business References (Supervisors)

Name:

Company:

Position:

Work Number:

Phone Number:

Name:

Company:

Position:

Work Number:

Phone Number:

Name:

Company:

Position:

Work Number:

Phone Number:

Name:

Company:

Position:

Work Number:

Phone Number:

Name:

Company:

Position:

Work Number:

Phone Number:

Personal References

Name:

Company:

Position:

Work Number:

Phone Number:

Name:

Company:

Position:

Work Number:

Phone Number:

Name:

Company:

Position:

Work Number:

Phone Number:

Name:

Company:

Position:

Work Number:

Phone Number:

Name:

Company:

Position:

Work Number:

Phone Number:

	Initials:	I hereby authorize Cooper Kenworth/Leasing, Inc. and it’s agent, DAC Services, to receive any criminal initial history record pertaining to me which may be in the files of any state or local criminal justice agency and to check my Motor Vehicle Record.
	Initials:	I also understand that if offered a position with Cooper Kenworth/Leasing, Inc. it will be pending negative initial results of a Substance Abuse Screening.
	Initials:	The information in this application for Employment is true, correct and complete. If employed, any initial misstatement or omission to fact on this application may result in dismissal.
	Initials:	I understand that acceptance of an offer of employment does not create a contractual obligation upon the initial employer to continue to employ me in the future.