BEE LINE TRUCKING, INC.

Mailing Address:

PO Box 172

Location Address:

**** ****

Ellenburg Depot, NY 12935

518-***-****

Ellenburg Depot, NY 12935

FAX 518-***-****

DRIVER'S APPLICATION FOR EMPLOYMENT

We are an equal opportunity employer. Applicants are considered for positions without regard to race, religion, sex, national origin, age, disability or any other category protected by applicable federal, state or local laws.

THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE ST ATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMP ANY MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT,CAUSE OR NOTlCE. POSITION APPLYING FOR COMPANY OWNER-OP

DATE OF APPLICATION: __ / __ / __

NAME: (Last, First, Middle): _

PRESENT ADDRESS (Street):

(City, State, Zip Code)

How long have you lived there? _

Previous Address: How long? __

Previous Address: How long? __

Date of Birth Commercial License# Social Security # License Expiration Date _ Telephone Number: L_)

Alternate or Cell Number: L__), _

Uunder the age of 18, can you produce the necessary work certificate at the time of employment? Yes __ No_ Type of employment desired? Full Time Part Time Date on which you can start work if hired_ Have you previously applied for employment with this Company? _ If yes, when did you apply? cccc c Have you ever been employed by this Company? If yes, provide dates of employment, locations reason for separation. _ Are you now employed

If not, how long since leaving last employment? _ How did you find out about Bee Line? _ INSTRUCTIONS FOR ANSWERING THE NEXT TWO QUESTIONS: All applicants: Do not include convictions that were sealed, eradicated, erased, annulled by a court or expunged, or convictions that resulted in referral to a diversion program. All pending arrests or criminal accusations must be disclosed. You are not required to disclose arrests or criminal accusations that resulted in criminal actions or proceedings which were terminated in your favor. Do not disclose criminal actions or proceedings that were sealed or c1assified as youthful offender adjudications. An ex offender who is denied employment may, upon written request, receive a statement oftbe reason(s) for denial within thirty (30) days of the applicants request for such information. Have you ever plead guilty or no contest to, or been convicted of any criminal offense other than the applicable exceptions Jisted above? Yes No __ _ Have you ever been arrested for any matters for which you currently are out on bail or on your own recognizance pending trial? Yes __ No __

CRIMINAL OFFENSES ONLY: If you answered Yes, to either of the above two questions, please provide the date(s) and explain in accordance with the above instructions so that individual circumstances can be considered. Criminal convictions or arrests will not automatically disqualify an applicant from a particular job. The Company will consider the nature of the crime, its seriousness, the substantial relation to the position's functions and qualifications, the number of occurrences, the applicant's age at the time of the crime, the time elapsed since the crime, the applicant's entire work and educational history, employment references and recommendations, and the business necessity of any exclusion when required by law. Have you ever initiated an act of violence in the workplace? Yes __ No __ If Yes, please provide the date(s) and explain so that individual circumstances can be considered. ( A "Yes" answer will not necessarily disqualify you from employment.) EDUCATION:

Highest Grade Completed

Last school attended: (Name) _

(City, State) _

List all special technical skills that you feel qualify you for the job which you are applying (For example, equipment operation, special tools or machines, etc.) WORK EXPERIENCE:

All driver applicants to drive in interstate commerce must provide complete infonnation on all employers during the preceding 3 years. Provide additional 7 years employment history driving any commercial motor vehicle in commerce (use additional sheets if necessary). All previous employers of past three years from date of this application will be contacted, for the purpose of investigating your safety performance history concerning general driver identification, employment verification, accident data elements, controlled substances and alcohol testing required by Federal Motor Carrier Safety Regulations found in 49 CFR 391.23 (d) and (e).

EMPLOYERS

Name: .From: __ / __ To: __ /_ Address: ---c Position _ City, State, Zip Wage _

Contact Person Subject to FMCSRs? _ Were you subject to DOT drug & alcohol testing requirements? _ Reason for Leaving: _

Phone Number: Fax Number: _ Name: .From: __ / __ To: __ / __ Address: Position _ City, State, Zip -c Wage _ Contact Person Subject to FMCSRs? _ Were you subject to DOT drug & alcohol testing requirements? _ Reason for Leaving: _ Phone Number: F.ax Number: _ Name: From: __ / __ To: __ / __ Address: Position _

City, State, Zip Wage _

Contact Person Subject to FMCSRs? _

Reason for Leaving: _

Phone Number: Fax Number: _

Please explain fully all gaps in your employment history in excess of one month. Have you ever been terminated or asked resign form any job? Yes __ No_ If Yes, how many times'?

-z

Have your employment ever been terminated by mutual agreement'? Yes_ No_ If yes, how many times'?_

-

Have you ever been given the choice to resign rather than be terminated'? Yes_ No_ If yes, how many times? __ If you answered Yes to any of the above three questions, please explain the circumstances of each occasion: _ ACCIDENT RECORD: (Must comprise the last 3 years)

Nature of Accident Fatalities Injuries

Last Accident _

Next Previous _

Next Previous _

(Attach a separate sheet if necessary)

EXPERIENCE & QUALIFICATIONS:

Driver License: State License No: _ Type: c- -cc- Expiration Date: cc Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No_ cc--

Has any license, permit or privilege ever been suspended or revoked? Yes No

Has your CDL ever been disqualified? Yes No _ IF THE ANSWER TO EITHER A, B OR C IS YES, ATTACH A STATEMENT GIVING DETAILS.

DRIVING EXPERIENCE:

Please indicate class of equipment, type of equipment, dates driven and approximate # of miles. List states operated in for last 5 years: _ List special courses or training that will help you as a driver: _ List any trucking, transportation or other experience that may help in your work for this company: _

PERSONAL REFERENCES (Not previous employers or relatives) Name Occupation _

Address # Yrs Known _

Phone _

Name Occupation _-c-cc Address #Yrs Known _

Phone _

The 49 CFR 40.25 requires the following information to be asked of individuals seeking to begin safety-sensitive duties for the first time, including any employee transferring into safety-sensitive functions as defined in 49 CFR 382.107.

You must answer the following questions regarding drug and alcohol testing to which you applied for, but did not obtain, safety-sensitive transpor1ation work covered by a DOT agency drug and alcohol testing rules during the past three years. Respond to the following questions by circling the response. 1. Did you ever test positive on any pre-employment drug test in the past three years? YES NO 2. Did you ever test positive on any pre-employment alcohol test in the past three years? YES NO 3. Did you ever refuse a pre-employment drug or alcohol test in the past three years? YES NO TffiS COMPANY OPERATES COMMERCIAL MOTOR VEIDCLES INTO CANADA. DRIVERS WITH PAST CRIMINAL CONVICTION(S) MAY BE TURNED BACK AT CANADA CUSTOMS. DO YOU HA VE ANY PAST CRIMINAL CONVICTION ANYWHERE FOR WffiCH YOU MAY BE DENIED ENTRY INTO CANADA? YES NO TO BE READ AND SIGNED BY APPLICANT

I authorize you to make such investigations and inquiries verifying my previous employment, previous DOT regulated employers' drug and alcohol test results, motor vehicle driving records and medical history cer1ification. 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 tales or misleading information given in my application or interview may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the company and the Federal Motor Carrier Safety Regulations, Federal Hazardous Materials Regulations and state laws. I understand the information I provide regarding current and/or previous employers may be used, and those employers will be contacted, for the purpose of investigating my safety performance history as provided by 49 CFR 391.23 (d) and (e). 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 prospective employer, and to have a rebuttal statement attached to the alleged erroneous information if the previous employers and I cannot agree on the accuracy of the information.

I understand that the Company may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state and local law. If the Company has such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under conditions requiring a drug-free workplace, consistent with applicable federal, state and local law. I also understand that all employees of the location, pursuant to the Company's policy and federal, state and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or illegal or controlled drugs. If employed, I understand that the taking of alcohol and/or drug testis is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company's policies and applicable federal, state and local law.

..

TIDS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF SIXTY (60) DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYEMTN AFTER THAT TIME, YOU MUST REAPPLY.

I CERTIFY THAT ALL OF THE INFORMATION THAT I HA VE PROVIDED ON TIDS APPLICATION IS TRUE, ACCURATE AND COMPLETE.

APPLICANT SIGNATURE _

PRINT NAME _

DATE __ / __ _f/ _

Contact this candidate