Driver Application

Applications may be submitted in person or online through the application below. Applications may be picked up at the Northstar Pulp & Paper office, submitted online or you can print out a PDF copy and bring it to our office. You can print out a copy below.

Print Application

Applicant Name:
Date of Application:

Northstar Pulp and Paper
89 Guion Street
Springfield, MA 01104

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.

TO BE READ AND SIGNED BY APPLICANT

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 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 understand, also, that I am required to abide by all rules and regulations of the Company.

I understand that information I provide regarding current and/or previous 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 (d) and (e). I understand that I have the right to:

Review information provided by previous employers;
Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employers; 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.

Signature:
Date:

________________________________________________________________________________

Position(s) Applied for:

Name:

Social Security Number:

List your addresses of residency for the past 3 years.

Current Address:
Street:

City:

State:

Zip Code:

How Long?

Previous Addresses:
Street:

City:

State:

Zip Code:

How Long?

Previous Addresses:
Street:

City:

State:
Zip Code:

How Long?

Phone:

Cellphone:

Email:

Do you have the legal right to work in the United States?YesNo
Date of Birth:
Can you provided proof of age?YesNo

Have you worked for this company before?YesNo
If so where?
From: To:
Position:

Reason for Leaving:

Are you now employed?YesNo
Please leave this field empty.
If not, how long since leaving last employment?

Who referred you?

Rate of pay expected?

Have you ever been bonded? YesNo
(Answer only if a job requirement)

Name of bonding company:

Have you ever been convicted of a felony?YesNo
If yes, please explain fully. Conviction of a crime is not an automatic bar to employment. All circumstances will be considered.

________________________________________________________________________________
________________________________________________________________________________

Is there any reason you might be unable to perform the functions of the job for which you have applied?
YesNo
If yes, explain if you wish:

________________________________________________________________________________

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code.

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years' information on these employers for whom the applicant operated such vehicle.
(NOTE: List employers in reverse order starting with the most recent.)

Employer Name:

Street:

City:

State:
Zip Code:

Person to Contact:

Telephone:

Date Employed:
From: To:
Position Held:

Reason for Leaving:

Where you subject to the FMCSRs while employed?YesNo
Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the Drug and Alcohol testing requirements of 49 CFR Part 40?YesNo

________________________________________________________________________________

Employer Name:

Street:

City:

State:
Zip Code:

Person to Contact:

Telephone:

Date Employed:
From: To:
Position Held:

Reason for Leaving:

________________________________________________________________________________

Employer Name:

Street:

City:

State:
Zip Code:

Person to Contact:

Telephone:

Date Employed:
From: To:
Position Held:

Reason for Leaving:

*Includes vehicles having GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

^The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

________________________________________________________________________________

ACCIDENT RECORD
For past 3 years or more. If none, write NONE

Last Accident
Date:
Nature of Accident: (Head-On, Rear-End, Upset, Etc)

Fatalities:

Injuries:

Hazardous Material Spill:

Next Previous
Date:
Nature of Accident: (Head-On, Rear-End, Upset, Etc)

Fatalities:

Injuries:
Hazardous Material Spill:

Next Previous
Date:
Nature of Accident: (Head-On, Rear-End, Upset, Etc)

Fatalities:

Injuries:

Hazardous Material Spill:

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE

Location:

Date:
Charge:

Penalty:

________________________________________________________________________________

Location:

Date:
Charge:

Penalty:

________________________________________________________________________________

EXPERIENCE AND QUALIFICATIONS - DRIVER
List all driver licenses or permits held in the past 3 years.

State:

License No.

Type:

Expiration Date:

________________________________________________________________________________

State:

License No.

Type:

Expiration Date:

________________________________________________________________________________

State:

License No.

Type:

Expiration Date:

________________________________________________________________________________

A. Have you even been denied a license, permit or privilege to operate a motor vehicle? YesNo

B. Has any license, permit or privilege ever been suspended or revoked?YesNo

If the answer is yes to either A or B, give details:

________________________________________________________________________________

DRIVING EXPERIENCE Check Yes or No

Class of Equipment

Straight Truck:YesNo
Type of Equipment: VanTankFlatDumpRefer
Dates:
From: To:
Approx. No. of Miles Total:

Tractor and Semi-TrailerYesNo
Type of Equipment: VanTankFlatDumpRefer
Dates:
From: To:
Approx. No. of Miles Total:

Tractor - Two Trailer:YesNo
Type of Equipment: VanTankFlatDumpRefer
Dates:
From: To:
Approx. No. of Miles Total:

Tractor - Three Trailer:YesNo
Type of Equipment: VanTankFlatDumpRefer
Dates:
From: To:
Approx. No. of Miles Total:

Motorcoach - School Bus (More than 8 passengers):YesNo
Type of Equipment: VanTankFlatDumpRefer
Dates:
From: To:
Approx. No. of Miles Total:

Motorcoach - School Bus (More than 15 passengers):YesNo
Type of Equipment: VanTankFlatDumpRefer
Dates:
From: To:
Approx. No. of Miles Total:

Other:

List states operated in for last five years:

Show special courses or training that will help you as a driver:

Which safe driving awards do you hold and from whom?

EXPERIENCE AND QUALIFICATIONS - OTHER

Show any trucking, transportation or other experience that may help in your work for this company:

List courses and training other than shown elsewhere in this application:

List special equipment or technical materials you can work with (other than those already shown)

EDUCATION

Select highest grade completed for High School:
Select highest grade completed for College:

Last school attended:

TO BE READ AND SIGNED BY APPLICANT
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.

Signature:

Date: