Safety Driver
Resume:
Cardinal Logistics
Management Corp.
Concord, NC 28027
**-**-**** *:20:32PM CDT
IntelliApp
Applicant opted out of D&A release authorization for the following individual employers / educational institutions. R Construction
Thank you for your interest in Cardinal Logistics Management Corporation. To apply for a driving position, please complete our online application for employment. Incomplete information will delay the processing of your application or prevent it from being submitted.
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.
Position City State/Province
CDL-A Truck Driver San Antonio TX
Personal Information
Referral Code: lf_jobs_trucks
Name Ezequiel Gomez
Residence 5 years or longer (If No,
previous addresses shown below)
Yes
Current Address 9202 Mission Stream
City, State/Province Zip/Postal San Antonio, TX 78223 Country United States
Residence 5 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 3223
Date of Birth
Primary Phone 210-***-****
Cell Phone 210-***-****
Preferred method of contact Cell Phone
Best time to contact you Any
Email ********@*****.***
Yes, I want to receive information and
communications from Cardinal Logistics
Yes
1
Management Corp. concerning future
opportunities or promotions.
Would you like to receive communication
from Cardinal Logistics Management Corp.
via text message?
By participating, you consent to receive
text messages sent by an automatic
telephone dialing system, which may
contain recruiting/advertising messages.
Consent to these terms is not a condition
of being hired, contracted, or leased. You
may opt out at any time by texting STOP to
unsubscribe. You also agree that Cardinal
Logistics Management Corp.'s service
provider receives in real time and logs your
text messages with Cardinal Logistics
Management Corp..
Yes
Company Questions
GENERAL INFORMATION
What position are you applying for? Company Driver License Class A
Do you have straight truck experience? Yes
Do you have flatbed experience? Yes
If "Owner/Operator", do you run under your
own authority?
No
Are you interested in Solo or Team? Solo
Have you ever been known by another
name?
Yes
Please list (and when): Zeke
Do you have the legal right to work in the
U.S.?
Yes
Have you ever previously applied for
employment/lease with a Cardinal
company?
No
Were you referred by a Cardinal
employee?
No
If yes, provide the Name and employee #:
What type of employee referred you?
How did you hear about this Cardinal
career opportunity?
Other
Please provide additional detail. For
example, if a newspaper or magazine,
Job2careers
2
which one?
Do you have a active passport? No
Are you an Owner / Operator? No
Equipment Description (Tractor):
Type:
Year:
Make:
Model:
Color:
VIN:
Weight
Mileage
Fifth Wheel Height
EXPERIENCE
Do you have 9 months within the past 3
years or 24 months within the past 5 years.
Yes
Do you have at least 12 months Grocery
experience?
Yes
Do you have at least 12 months Reefer
experience?
Yes
Do you have at least 12 months Van
experience?
Yes
Do you have at least 12 months Tanker
experience?
Yes
Licenses
List all driver licenses held in the past five years (include multiple licenses if you have them).
License Number 365
State/Province TX
Country United States
License Class Class A
License Expiration Date 06-01-2021
Physical Expiration Date 06-03-2019
Current License Yes
Commercial Driver License Yes
3
Endorsements
Tanker Endorsement Yes
HAZMAT Endorsement Yes
X Endorsement Yes
Doubles Triples Endorsement Yes
Other Endorsement No
Employment / Unemployment
Thatcher Trucking
Company Thatcher Trucking
Start Date 04-2020
End Date 04-2020
Address 255 Broken Arrow
City, State/Province Zip/Postal Floresville, TX 78114 Country United States
Phone 210-***-****
Position Held Driver
Reason for leaving? Better opportunities
Were you terminated/discharged/laid off? No
Is this your current employer? Yes
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT, and
subject to drug and alcohol testing?
Yes
Areas Driven Local
Miles driven weekly 500-1000
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer Flatbed
4
Trailer length 45 to 52 feet
Thatcher Trucking
Company Thatcher Trucking
Start Date 03-2020
End Date 03-2020
Address Broken Arrow
City, State/Province Zip/Postal Floresville, TX 78114 Country United States
Phone 210-***-****
Position Held Delivery driver
Reason for leaving? No benefits
Were you terminated/discharged/laid off? No
Is this your current employer? Yes
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT, and
subject to drug and alcohol testing?
Yes
Areas Driven Austin and vicinities
Miles driven weekly 1000-1500
Pay Range (cents/mile)
Most common truck driven Conventional Tractor
Most common trailer Flatbed
Trailer length 45 to 52 feet
Thatcher Trucking
Company Thatcher Trucking
Start Date 07-2019
End Date 02-2020
Address Broken Arrow
City, State/Province Zip/Postal Floresville, TX 78114 Country United States
5
Phone 210-***-****
Position Held Delivery driver
Reason for leaving? No benefits
Were you terminated/discharged/laid off? No
Is this your current employer? Yes
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT, and
subject to drug and alcohol testing?
Yes
Areas Driven Texas
Miles driven weekly 1000-1500
Pay Range (cents/mile)
Most common truck driven Conventional Tractor
Most common trailer Flatbed
Trailer length 45 to 52 feet
Skyline Transport Group
PLEASE DO NOT CONTACT
Company Skyline Transport Group
Start Date 03-2018
End Date 06-2019
Address 4515 Smith Rd.
City, State/Province Zip/Postal Von Ormy, TX 78217 Country United States
Phone
Position Held Tanker driver
Reason for leaving? Company closed
Were you terminated/discharged/laid off? No
Is this your current employer? No
May we contact this employer at this time? No
6
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT, and
subject to drug and alcohol testing?
Yes
Areas Driven Texas
Miles driven weekly 1000-1500
Pay Range (cents/mile)
Most common truck driven Conventional Tractor
Most common trailer Tank Trailer
Trailer length 45 to 52 feet
R Construction
Company R Construction
Start Date 07-2017
End Date 02-2018
Address P.O. Box 189
City, State/Province Zip/Postal Buffalo, TX 75831
Country United States
Phone 903-***-****
Fax 903-***-****
Position Held Truck Driver
Reason for leaving? Violation of CO. policy
Were you terminated/discharged/laid off? Yes
Termination Explanation Told supervisor of a moving violation that had occured the day before 1/25/18.
Is this your current employer? No
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
No
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
7
Did you perform any safety sensitive
functions in this job, regulated by DOT, and
subject to drug and alcohol testing?
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven
Most common trailer
Trailer length
R. Constrution
Company R. Constrution
Start Date 06-2014
End Date 06-2017
Address
City, State/Province Zip/Postal Floresville, TX
Country United States
Phone
Position Held
Reason for leaving? N/A
Were you terminated/discharged/laid off? No
Is this your current employer? Yes
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT, and
subject to drug and alcohol testing?
Yes
Areas Driven South Texas
Miles driven weekly 500-1000
Pay Range (cents/mile)
Most common truck driven Tanker
Most common trailer Tank Trailer
8
Trailer length 45 to 52 feet
R. Construction
Company R. Construction
Start Date 02-2010
End Date 05-2014
Address 4776 Hwy 97 W.
City, State/Province Zip/Postal Floresville, TX 782114 Country United States
Phone
Position Held Saltwater hauler
Reason for leaving? Not enough work
Were you terminated/discharged/laid off? No
Is this your current employer? No
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT, and
subject to drug and alcohol testing?
Yes
Areas Driven Texas
Miles driven weekly 500-1000
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer Tank Trailer
Trailer length 45 to 52 feet
Motor Vehicle Record
1. Has any license, permit or privilege ever
been denied, suspended or revoked for
any reason?
No
2. Have you ever been convicted of driving
during license suspension or revocation, or
driving without a valid license or an expired
No
9
license, or are any charges pending?
3. Have you ever been convicted for any
alcohol or controlled substance related
offense while operating a motor vehicle, or
are any charges pending?
No
4. Have you ever been convicted for
possession, sale or transfer of an illegal
substance (including but not limited to,
marijuana, amphetamines, or derivatives
thereof) while on duty, or are any charges
pending?
No
5. Have you ever been convicted of
reckless driving, careless driving or
careless operation of a motor vehicle, or
are any charges pending?
No
6. Have you ever tested positive, or
refused to test on a pre-employment drug
or alcohol test by an employer to whom
you applied, but did not obtain
safety-sensitive transportation work
covered by DOT agency drug and alcohol
testing rules in past three years, or have
you ever tested positive or refused to test
on any DOT-mandated drug or alcohol
test?
No
Vehicle Accident Record
Were you involved in any accidents/incidents with any vehicle in the last 5 years (even if not at fault)?
Type of Accident / Incident Non-Injury
Date of Accident / Incident 05-2016
Nature of Accident / Incident
Hazmat Accident / Incident No
Was the vehicle towed away? No
City Seguin
State/Province TX
Were you in a commercial vehicle? Yes
If yes, was this a Department of
Transportation recordable accident?
Yes
Were you at fault? No
Were you ticketed? No
Description Upon exiting hwy,I stop at a stop sign before making a right turn. taking a wide
10
turn with my signal on, driver tried passing
me on the right therefore hitting the back of
the trailer i was pulling. Driver stated he
did not see my signal.
Traffic Convictions \ Violations
Have you had any moving violations or traffic convictions in the past 5 years? Violation Date 08-2015
Charge / Description Improper Lane Change
Violation State/Province TX
In Commercial Vehicle Yes
Fined? Yes
License Suspended?
License Revoked?
Perform Community Service?
Other Penalty?
Fine Amount (if any): $200 - $299
Comments:
Signature
Full Name Ezequiel Gomez
IP Address 45.16.113.1
Signature Date/Time 04-05-2020 3:20 PM
By signing my application below, I agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature. 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.
Signed Date: 04-05-2020 3:20 PM
Signed:
11
Federal FCRA Summary of Rights Acknowledgment
By checking this box, I (a) acknowledge
that I have read and understand the
federal FCRA Summary of Rights and
have been given the opportunity to
copy/print the Summary of Rights and (b)
agree to use an electronic signature to
demonstrate my consent. An electronic
signature is as legally binding as an ink
signature.
Yes
PSP Disclosure and Authorization
By checking the box, I (a) acknowledge
that I have read and understand the PSP
Disclosure and Authorization and also
have been given the opportunity to
copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
Additional Consent or Certification
By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
FCRA Disclosure and Authorization
By my check of this box, I represent that I
understand and agree to the above
Controlled Substance and Alcohol Use and
Testing Authorization.
Yes
Employment Verification Acknowledgment and Release (DOT Drug and Alcohol) By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
12
Clearinghouse Release
By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse begins January 6, 2020
Checking the box acknowledges receipt of
educational information required by 49
CFR §382.601(b)(12).
Yes
Summary of Rights Under 15 U.S.C. Section 1681m(a) By checking the box, I (a) acknowledge
that I have read and understand the
Summary of Rights Under 15 U.S.C.
Section 1681m(a) and have been given
the opportunity to copy/print the 1681m
Summary of Rights and (b) agree to use
an electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
California State Release
I agree to the above language Yes
Background Investigation Authorization
I agree to the above language Yes
By my check of this box, I represent that I
understand and agree to the above.
Yes
User Requested Copy
User requested a copy to be sent to this
email address ********@*****.***.
Yes
13
Cardinal Logistics Management Corporation
and its affiliated motor carriers
AUTHORIZATIONS AND CERTIFICATIONS
I understand that as part of the Department of Transportation Driver Qualification process (specifically DOT 49 CFR Parts 382 CONTROLLED SUBSTANCES AND ALCOHOL USE AND TESTING), Cardinal Logistics Management Corporation is required to obtain certain information relating to DOT required drug and/or alcohol tests (including refusals to be tested). I give Cardinal Logistics Management Corporation written authorization to obtain the information listed below from all of the companies for which I performed a safety sensitive function, or for which I took a pre-employment and/or non-DOT drug and/or alcohol test, during the past three years. I understand that my signing of this authorization does not guarantee me employment or a lease with Cardinal Logistics Management Corporation. On my application, I have listed all of the companies for which I performed a safety sensitive function, or for which I took any drug and/or alcohol test, during the past three years. I hereby authorize the companies to furnish Cardinal Logistics Management Corporation the following information concerning my drug and /or alcohol tests: 1. All verified positive drug test results during the past three years. 2. All alcohol tests with a result of 0.04 or higher alcohol concentration during the past three years. 3. All refusals to be tested (including verified adulterated or substituted drug test results) during the past three years. Any violations of DOT agency drug and alcohol testing regulations or alcohol and controlled substance prohibitions during the past three years.
4.
5. Any drug and/or alcohol rule violations provided by a previous employer/lessor during the past three years. Documentation of successful completion of DOT return to duty requirements, to include SAP information and follow-up tests and/or documentation of non-completion or refusal of SAP referral during the past three years. 6.
7. All testing violations subsequent to the successful completion of SAP rehabilitation during the past three years. I acknowledge that I will be required and agree to submit to a physical examination and controlled substance and/or alcohol use testing as part of Cardinal Logistics Management Corporation evaluation procedures and authorize release of my results to Cardinal Logistics Management Corporation and Cardinal Logistics Management Corporation's use of those results in deciding whether I should be offered or continued in employment/lease;
•
I acknowledge that illegal alcohol or drug use during my employment/lease will be grounds for immediate termination of employment or lease;
•
I authorize Cardinal Logistics Management Corporation and its agents to use my Social Security Number and Drivers License Number(s) to investigate my background, including but not limited to, my character, general reputation, record of convictions, deferred prosecutions, charges pending, motor vehicle records and prior employment/lease, by contacting my prior employers/lessors, references or any other individuals or agencies Cardinal Logistics Management Corporation considers necessary;
•
I authorize Cardinal Logistics Management Corporation, my prior employers/lessors, educational institutions, references, and any other individuals or agencies contacted by Cardinal Logistics Management Corporation to release any and all information they may have regarding me and absolve those parties who provide information requested from any and all liability related to their doing so;
•
• I acknowledge that any employment/lease offered to me may be terminated by Cardinal Logistics Management Corporation at any time; I agree that not updating, or providing false, misleading or incomplete statements or data in this application and/or supplemental documents is grounds for immediate termination of my employment/lease, regardless of when such information is discovered.
•
I understand that in order to investigate my safety employment history, per FMCSA regulations, Cardinal Logistics Management Corporation must investigate the information I have provided by contacting all previous DOT regulated employers/lessors under which I was employed/leased in a safety-sensitive function within the previous three years from the date of this employment/lease application. Driver applicants have the following rights regarding the investigative information that will be provided to Cardinal Logistics Management Corporation pursuant to FMCSA Reg 391.23 (i) (1):
The right to review investigative information provided by previous DOT employers/lessors for the preceding three years by submitting a written request to Cardinal Logistics Management Corporation, ATTN: VP Human Resources 5333 Davidson Hwy, Concord, NC 28027
(Employer/Lessor), within 30 days after being employed/leased or of being notified of denial of employment/lease. 1.
The right to have errors in the information corrected by their previous employer/lessor and for that previous employer/lessor to re-send the corrected information to Cardinal Logistics Management Corporation. Applicants must send the request for the correction to the previous employer/lessor that provided the records to Cardinal Logistics Management Corporation. 2.
The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer/lessor and the applicant cannot agree on the accuracy of the information. Applicant must send the rebuttal to the previous employer/lessor with instructions to include the rebuttal in that applicant's safety performance history. 3.
I certify by my signature that I completed this form and that all entries and information on and in it and all supplemental documents are true and complete to the best of my knowledge and I hereby agree to all of the above. Cardinal Logistics Management Corporation hiring/leasing criteria and application process may be changed at any time at Cardinal Logistics Management Corporation discretion without prior notice. Applications will remain action for a period of six months from date completed. 14
Printed Name:
Ezequiel Gomez
Social Security #:
3223
Signed Date: 04-05-2020
Ezequiel Gomez
9202 Mission Stream
San Antonio, TX 78223
Gender:
15
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Cardinal Logistics Management Corp. ("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 Cardinal Logistics Management Corp. ("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. 16
Printed Name:
Ezequiel Gomez
Signed Date: 04-05-2020
17
Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse
I hereby provide consent to Cardinal Logistics Management Corp. to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I understand this consent shall remain on file and shall serve as ongoing consent for Cardinal Logistics Management Corp. to conduct multiple limited queries of the Clearinghouse at any time during my employment or contract period without asking me for additional consent.
I understand that if I refuse to provide consent for Cardinal Logistics Management Corp. to conduct a limited query of the Clearinghouse, Cardinal Logistics Management Corp. is required to prohibit me from performing safety-sensitive functions, including operating a commercial motor vehicle.
I understand that if the limited query conducted by Cardinal Logistics Management Corp. indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to Cardinal Logistics Management Corp. unless I give additional specific consent within the Clearinghouse. However, I understand that Cardinal Logistics Management Corp. will be required to conduct a full query of the Clearinghouse within 24 hours after a limited query indicates that drug or alcohol information exists and that if I do not grant consent within the Clearinghouse for that full query I will be removed from performing safety-sensitive functions, including operating a commercial motor vehicle. 04-05-2020
Ezequiel Gomez Date
18
TO BE READ AND SIGNED BY APPLICANT
I certify by my signature that I completed this application and that all entries and information on and in this application and all supplemental documents are true and complete to the best of my
Contact this candidate